Well Woman Care

At your annual health care visit, you and your health care provider may discuss the following health issues:

Sexuality and Reproductive Planning

• Sexual problems or concerns
• Preventing sexually transmitted diseases (such as condom use)

Fitness and Nutrition

• Physical activity
• Nutrition (including eating disorders and weight concerns)
• Important vitamins and minerals (such as folic acid and calcium)

Cardiovascular Risk Factors

• Family history of heart disease
• Personal risk factors for heart disease, such as high blood pressure, elevated cholesterol, obesity, and diabetes
• Personal history of preeclampsia, gestational diabetes, or pregnancy-induced hypertension

Your Relationships and Mental Health

• Your family relationships
• Intimate partner violence
• Neglect and abuse
• Lifestyle and stress
• Sleep disorders
• Advance directives

Other Topics

• Use of complementary and alternative medicine
• Aspirin to reduce the risk of stroke if you are younger than 79 years; talk to your health care provider before starting an aspirin regimen.
• Breast self-awareness (may include breast self-examination)
• Hormone therapy (Risks, Benefits and Alternatives)
• Dental hygiene
• Injury prevention: exercise and sports safety, firearms safety, occupational and recreational hazards, prevention of falls
• Safe driving practices: seat belt use, no distracted driving or driving while under the influence of substances
• Sun exposure
• Depression and suicide
• Tobacco, alcohol, vaping other drug use
• Vision
• Menopausal symptoms
• Urinary and fecal incontinence
• Pelvic support problems

If you have certain risk factors, you may need additional exams or tests other than those recommended for your age group. To find out if you need additional exams or tests, answer the following questions:

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Bone Mineral Density Screening

• Are you a postmenopausal woman younger than 65 years and have one of the following:
  • Have a personal history of fracture as an adult
  • Have a family history of osteoporosis
  • Are Caucasian
  • Have dementia
  • Eat a poor diet or are not physically active
  • Smoke cigarettes
  • Have alcoholism
  • Low weight and body mass index
  • Have low levels of estrogen caused by early menopause (younger than 45 years), removal of both ovaries, or absence of menstrual periods for more than 1 year
  • Low lifelong calcium intake
  • Impaired eyesight (despite adequate correction)
  • History of falls
• Do you have certain diseases or medical conditions or take certain drugs that increase the risk of osteoporosis?

If you answer yes to any of these questions, bone mineral density screening is recommended.

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Enhanced Breast Cancer Screening

• Have you had a positive test result for BRCA1 or BRCA2 mutations?
• Has your mother, sister, or daughter had a positive test result for BRCA1 or BRCA2 mutations, but you have had a negative test result or you have not been tested?
• Is your lifetime risk of breast cancer estimated to be 20% or greater based on various questionnaires designed to calculate breast cancer risk?
• Do you have a history of breast biopsy results that are associated with a high risk of breast cancer?
• Did you receive thoracic irradiation (typically as a treatment for lymphoma) between the ages 10 years and 30 years?

If you answer yes to any of these questions, enhanced breast cancer screening is recommended. Enhanced breast cancer screening may include more frequent clinical breast exams, yearly magnetic resonance imaging tests, and instruction in how to do a breast self-exam.

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Colorectal Cancer Screening

• Do you have a first-degree relative (parent, sibling, or child) younger than 60 years or two or more first-degree relatives of any age who have had colorectal cancer or adenomatous polyps?
• Do you have a family history of familial adenomatous polyposis or hereditary nonpolyposis colon cancer?
• Do you have a personal history of colorectal cancer, adenomatous polyps, inflammatory bowel disease, chronic ulcerative colitis, or Crohn disease?

If you answer yes to any of these questions, colorectal cancer screening is recommended.

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Diphtheria and Reduced Tetanus Toxoids and Acellular Pertussis Vaccine (tdap)

• Do you have or will have close contact with an infant aged less than 12 months?
• Are you are a health care provider?

If you answer yes to any of these questions, diphtheria and reduced tetanus toxoids and acellular pertussis vaccine (tdap) is recommended.

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Diabetes Testing

• Are you overweight (BMI equal to or greater than 25) or are not physically active?
• Do you have a first-degree relative with diabetes mellitus?
• Are you a member of a high-risk race or ethnic group for diabetes (African American, Latin American, Native American, Asian American, or Pacific Islander)?
• Have you given birth to a newborn weighing more than 9 pounds or do you have a history of gestational diabetes mellitus?
• Do you have high blood pressure?
• Do you have a high-density lipoprotein cholesterol level of 35 mg/dL or less or a triglyceride level greater than 250 mg/dL?
• Do you have a history of impaired glucose tolerance or impaired fasting glucose?
• Do you have polycystic ovary syndrome?
• Do you have a history of vascular disease?
• Do you have other clinical conditions associated with insulin resistance?

If you answer yes to any of these questions, diabetes testing is recommended.

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Genetic Testing and Counseling

• Are you considering pregnancy? If yes, do any of the following statements apply to you?
  • You, your partner, or a family member has a history of a genetic disorder or birth defect.
  • You have been exposed to a substance known to cause genetic defects.
  • You are of African, Cajun, Caucasian, European, Easter European Jewish, French Canadian, Mediterranean, or Southeast Asian ancestry.

If you answer yes to any of these questions, genetic testing and counseling is recommended.

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Hemoglobin Level Assessment

• Are you of Caribbean, Latin American, Asian, Mediterranean, or African ancestry?
• Do you have a history of heavy menstrual periods?

If you answer yes to answer of these questions, hemoglobin level assessment is recommended.

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Hepatitis A Vaccine

• Do you have chronic liver disease?
• Do you have a clotting factor disorder?
• Do you use illegal drugs?
• Do you work with hepatitis A virus or nonhuman primates in a research setting?
• Are you traveling to a country where hepatitis A is common?

If you answer yes to any of these questions, hepatitis A vaccine is recommended.

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Hepatitis B Vaccine

• Have you had more than one sex partner in the past 6 months?
• Are you being evaluated or treated for a sexually transmitted disease?
• Have you recently or do you currently inject illegal drugs?
• Do you have a job that exposes you to human blood or other body fluids?
• Do you have a sexual partner who is infected with hepatitis B virus?
• Do you live with someone infected with hepatitis B?
• Do you live or work in an institution for the developmentally disabled?
• Do you have end-stage renal disease?
• Are you on dialysis?
• Do you have chronic (long-term) liver disease?
• Are you traveling to a country where hepatitis B is common?
• Are you infected with human immunodeficiency virus (HIV)?
• Are you younger than 60 years and have diabetes?

If you answer yes to any of these questions, hepatitis B vaccine is recommended.

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Hepatitis C Testing

• Are you infected with human immunodeficiency virus (HIV)?
• Do you have a history of injecting illegal drugs?
• Did you received clotting factors before 1987?
• Are you on dialysis?
• Do you have abnormal liver enzyme test results?
• Did you receive blood or have an organ transplant before 1992?
• Have you received blood from someone who later tested positive for hepatitis C?
• Are you a health care worker who may have been exposed to hepatitis C-positive blood (for example, you have been stuck with a needle used on a person with hepatitis C)?

If you answer yes to any of these questions, hepatitis C testing is recommended.

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Human Immunodeficiency Virus Testing

• Have you had more than one sexual partner since your most recent HIV test or do you have a sexual partner with more than one sexual partner since his or her most recent HIV test?
• Have you had a past or present sex partner who injects drugs or is HIV positive?
• Do you have a history of prostitution?
• Do you inject illegal drugs?
• Are you an adolescent entering a detention facility?
• Have you been diagnosed with a sexually transmitted disease in the past year?
• Have you lived for a long period or were you born in an area with high prevalence of HIV infection?
• Did you receive a blood transfusion between the years 1978 and 1985?
• Do you have invasive cervical cancer?
• Are you seeking preconception evaluation?

If you answer yes to any of these questions, human immunodeficiency virus testing is recommended.

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Testing for Sexually Transmitted Diseases

• Have you had more than one sexual partner or do you have a partner who has had more than one sexual partner?
• Have you had sexual contact with someone with a sexually transmitted disease?
• Have you had more than one sexually transmitted disease or been treated at a sexually transmitted disease clinic?

If you answer yes to any of these questions, testing for sexually transmitted diseases is recommended.

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Syphilis Testing

• Are you a sexually active adolescent and do any of the following statements apply to you?
  • You exchange sex for drugs or money.
  • You inject illegal drugs.
  • You are entering a detention facility.
  • You live in an area with high rates of syphilis.

If you answer yes to any of these questions, syphilis testing is recommended.

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