Complaints about a chosen method that had previously been satisfactory should not be taken at face value. Once medical reasons for the problem have been excluded the doctor must try to understand what other conflicts may be present. Similarly erratic use of a method, especially in a patient who has always been a regular user, should occasion concern and further exploration, in order to ascertain what is really going on in the patient’s life. Older women, for instance, can begin to realize that the biological time clock is ticking away, and that they may have left the decision to have a baby too late. Sometimes they only want to know that they can get pregnant, and once they have done so they may request termination. A change from a reliable to a less reliable method may also reflect a covert wish to get pregnant even although that is denied consciously.
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