Dr. Peterson is Chief, Women's Health and Fertility Branch, Division of Reproductive Health, Centers for Disease Control and Prevention, and Clinical Professor, Department of Gynecology and Obsterics, Emory University School of Medicine, Atlanta, Ga; and Clinical Professor, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC.
Clinical Crossroads at Beth Israel Deaconess Medical Center is produced
and edited by Thomas L. Delbanco, MD, Jennifer Daley, MD, and Richard A. Parker,
MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor:
Margaret A. Winker, MD, Senior Editor, JAMA.
DR DELBANCO: Mrs B is a 40-year-old, married
nurse who has 3 children. She and her husband have decided not to have more
children and are considering how to prevent pregnancy in the future. Her insurance
is through a managed care organization.
Mrs B experienced menarche at age 12 years. She is generally healthy,
does not smoke, and has been pregnant 5 times. She has 3 healthy children
and had a spontaneous miscarriage, in addition to a voluntary abortion when
she was younger. Mrs B has used several methods of contraception. During college
she tried an intrauterine device (IUD), but had difficulty and had it removed.
Subsequently, she used a diaphragm until her mid-30s. Only 1 of her children
was planned, and she feels that the other pregnancies may have resulted from
imperfect use of the diaphragm. After the birth of her youngest child, she
began to use both a diaphragm and condoms.
Peterson HB. A 40–Year-Old Woman Considering Contraception. JAMA. 1998;279(20):1651-1658. doi:10.1001/jama.279.20.1651