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Clinical Crossroads |

A 40–Year-Old Woman Considering Contraception

Herbert B. Peterson, MD
JAMA. 1998;279(20):1651-1658. doi:10.1001/jama.279.20.1651.
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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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