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A 40-Year-Old Woman Considering Contraception, 1 Year Later
Thomas Delbanco, MD;
Erin E. Hartman, MS
From the Division of General Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.
JAMA. 1999;281:374.
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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.
Dr Peterson discussed the high prevalence of unplanned pregnancy among women in the later childbearing years. In addition to the strategies Mrs B had already . . . [Full Text of this Article] MRS B, THE PATIENT
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