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Clinical Crossroads Update
January 27, 1999

A 40-Year-Old Woman Considering Contraception, 1 Year Later

JAMA. 1999;281(4):374. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-4-jxu80010

At the Obstetrics and Gynecology Grand Rounds held in February 1998, Herbert Peterson, MD, discussed options for contraception in a 40-year-old nurse who is married and has 3 children.1 Despite using several methods of contraception, including an intrauterine device, a diaphragm, a combination of diaphragm and condoms, and oral contraceptives, Mrs B had 5 pregnancies, only 1 of which was planned. Eighteen months prior to the Grand Rounds, she developed severe premenstrual emotional lability. This was alleviated by oral contraceptives which, on occasion, she would forget to take. They also seemed to induce intermittent headaches, relieved by ibuprofen. Mrs B was eager not to become pregnant again, and she and her husband were considering various options, including vasectomy.