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Clinical Crossroads
May 27, 1998

A 40–Year-Old Woman Considering Contraception

Author Affiliations

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.

JAMA. 1998;279(20):1651-1658. doi:10.1001/jama.279.20.1651

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.

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