Feeling stressed or depressed can make it harder to do all kinds of basic things —like get to work or school, sleep well, and make decisions. Turns out it can also make it harder to stay on top of your birth control.

The study

Almost 700 women in Michigan, ages 18-19, took part in a multi-year study that asked them about their sex lives and their use of birth control. About one in four of them felt stressed out or depressed at the start of the study. Over the next year, the study found that:

• Women who used high-maintenance methods—namely the pill , condoms , or withdrawal —were most likely to forget to use their method or use it inconsistently.

• The women who felt stressed were more likely to use their birth control inconsistently compared to women who weren’t stressed (40% v. 25%). Same for women who felt depressed in comparison to those who didn’t (36% v. 26%).

The connection

There are lots of ways that stress or depression could affect birth control use. Feeling depressed can make it a challenge to keep up with routine responsibilities like taking a pill every day or stopping by the clinic or pharmacy to refill a prescription. Folks dealing with stress or depression might have a harder time dealing with side effects from birth control. In fact, the same researcher found in earlier studies that women who felt depressed and stressed were more likely to notice changes in their weight or mood; they were also more likely to quit the pill.

Some women may feel stressed or depressed to begin with because their partners are messing with their birth control or failing to use a condom or pull out when they say they will.

The take-away

If you’re feeling stressed out or depressed, the first thing to do is talk to a health care provider about it—even if the visit is about birth control or something seemingly unrelated. Your provider may be able to help you figure out how serious your stress or depression is —and they should definitely be able to help you find local or online support .

In an ideal world, all people would have the support and medical care they needed to manage stress and depression. In the meantime, study researcher Kelli Stidham Hall says super-effective, low-maintenance methods like IUDs or the implant may make life a little easier for women who are dealing with depression or stress. “Long-acting reversible contraception are highly effective methods which may be ideal options for women with depression or stress symptoms, who may be dealing with other life issues and don’t want to worry about their birth control.”