Hailey Bieber Wants You to Talk to Your Doctor Before Starting Birth Control

A month after recovering from a mini stroke, model Hailey Bieber took to Instagram to explain what may have caused the small blood clot in her brain that led to stroke-like symptoms.

Bieber’s doctors told her that three factors likely contributed to the blood clot: a recent long-haul flight to and from Paris, recovering from COVID-19, and her recent prescription of birth control pills.

“I had just recently started birth control pills, which I should’ve never been on because I am someone who suffers from migraines anyway, and I just did not talk to my doctor about this,” Bieber said in her video. “So, ladies, if you suffer from bad migraines and you plan on being on birth control pills make sure you tell your doctor, because having a stroke is a potential side effect.”

Migraine with aura can lead to sensory disturbances that are similar to a stroke, such as tingling in an arm, numbness in the face, or slurred speech. This condition affects about 25%–30% of people who have migraines, according to the American Migraine Foundation.

People with a history of migraine with aura have slightly elevated risks of blood clots and stroke, especially if they smoke or take birth control pills. This means people living with this kind of migraine should evaluate the risk of estrogen-containing oral contraceptives with their healthcare providers, said Jessica Shepherd, MD, Verywell’s chief medical officer and a certified obstetrician-gynecologist.

“It really can change the game on whether there is a relative risk between an oral contraceptive that has estrogen in it, and whether or not you have aura,” Shepherd said.

According to the American Migraine Foundation, those who experience migraines without aura do not appear to have higher risk for side effects like a stroke when on birth control.

Does Birth Control Help or Worsen Migraine?

Women are two to three times more likely to have migraines than men, but messaging and research on migraine are lacking and unclear.

When it comes to birth control, medical advice can be muddled. In some cases, birth control pills may help reduce symptoms of menstrual migraines by keeping estrogen levels constant.

“The high prevalence of migraine in women in relation to the menstrual cycle has had some implications with estrogen drop,” Shepherd said. Estrogen levels drop significantly after ovulation and right before menstruation, the time when migraines are most likely to occur.

More Conversations on Contraceptive Risks

Bieber’s experience isn’t a cause for everyone to jump to alarm, but it’s a good incentive to begin or continue conversations about contraceptive risks, said Elizabeth Ruzzo, PhD, founder of adyn, an up-and-coming birth control company that prioritizes risk assessments in prescriptions.

“It doesn’t mean you should be scared of hormonal birth control. It’s a matter of being matched to the one that’s best for you,” Ruzzo said.

Options like IUDs or transdermal patch have not been associated with significant increase in stroke risk for people with or without migraines, according to a 2014 study in the journal Stroke. The vaginal ring, however, may pose a similar risk to estrogen-based pills.

Pills containing only progesterone—a sex hormone that keeps a balance with estrogen—have not been shown to increase risk of stroke, according to the American Migraine Foundation.

In the past, Ruzzo experienced painful side effects from birth control, including suicidality and uterine fibroids, which are common in many women. These motivated Ruzzo to challenge the standard of contraceptive care, which is an ongoing battle.

“For the longest time I think people didn’t talk badly about the pill because the pill also meant ‘freedom,’” Ruzzo said. “Now people are demanding and calling out that we need a better standard of care.”