SUMMARY:

Obstetrician-gynecologists have traditionally played an important role in preventative care for women. Data has established that female patients often obtain most of their care from women’s health specialists. Changes in cervical cancer screening recommendations, as well as patients choosing long-term contraception, can result in several years elapsing between visits with health care provider. ACOG supports continued periodic visits that focus also on age-based screening, counseling, immunizations as well as evaluation of women’s health concerns.

History and Physical Exam

History

• Include
  • Review of symptoms
  • Obstetric and gynecologic history (including sexual and reproductive health)
  • Medical and surgical history
  • Family history | Focus on identifying possible familial diseases (e.g., heritable breast cancer)
  • Social history
  • Mental health screening
• Review of medications | Allergies

Physical Examination

• A comprehensive history can inform shared decision-making regarding components of the physical exam
• ACOG recommends performing pelvic and breast examinations based on medical history or symptoms

Discussion Of Reproductive Goals

• Contraceptive options
• Infertility evaluation
• Pre-pregnancy health optimization             

Screening for Risk Factors

• Identify patients who are at risk for chronic health conditions (e.g., diabetes, CVD )
• Screen using validated tools for
  • Alcohol use | Tobacco use | Substance use
• Discuss
  • Exercise | Diet
  • Discontinuation or change in lifestyle if needed
• Referral for further treatment when appropriate

Patient Preference

Research Regarding Patient Preference for ObGyn Care Teams

• Women prefer to receive care from women’s health specialists (e.g., ObGyn and family planning clinics) for regular reproductive healthcare including
  • Cervical cancer screening | Contraception | STI services
• Research suggests that guideline changes associated with increased time intervals between cervical cancer screening visits as well as increased LARC uptake could lead to reduced ObGyn visits for well-woman care

KEY POINTS:

• Consider team-based care in order to cover all aspects of preventative services
  • Physicians | NPs | PAs | Mental health providers | Other health professionals
• More than one encounter may be needed in order to address the patients care
• Exact interval between well-woman visits should be individualized based on patient age, medical condition and lifestyle
• Access to appropriate and current information is essential to provide high quality care
• Well-women visits should screen for disease as well as for patient safety, contraception, and family planning goals
• Obstetrician-gynecologists are in a unique position to discuss the impact of risk factors related to gynecologic and fertility concerns including opportunities to potentially improve outcomes in future generations

Learn More – Primary Sources:

ACOG Committee Opinion 755: Well-Woman Visit

Related ObG Topics:

Does Alcohol Consumption Increase or Decrease Mortality, CVD and Cancer Risk?  

Time for a Second Look: Are the “New Tobacco” Products Safer than in Years Past?

Changes in CDC Vaccination Guidance 2020

USPSTF Guidelines for Primary Care Clinicians: BRCA-Related Cancer Risk Assessment

Mammography Guidelines for Average-Risk Women

ACOG & USPSTF Guidance: Still a Role for the Annual Pelvic Exam?

What is Shared Decision Making?

Primary Care Screening: USPSTF Recommendations for Your Patient