ACOG updates its Recommendations for Well-Woman Care

The American College of Obstetrics and Gynecology (ACOG) recently updated its guidance on well- women care with an emphasis on the vital role an Ob/Gyn plays in maintaining the overall health of women from menarche to menopause and beyond.

The update coincides with the release of ACOG-led Women’s Preventive Services Initiative’s (WPSI) new Well-Woman Chart. The guidance titled “Well Women Visit” was published in the October issue of Obstetrics and Gynecology and replaces the earlier opinion released in August 2012.

The new guidance emphasizes the performance of physical examination (breast and pelvic examination) when indicated by age-group, history or symptoms. The committee also identified the Well-Woman Chart from the WPSI, U.S. Preventive Services Task Force (USPSTF) and Bright Futures, as an important tool to identify the different components of the comprehensive preventive services offered.

Looking at the chart, the Ob/Gyn or other women’s health care providers can prioritize the component for a timely and detailed approach for continuous preventive care throughout the entire lifespan. The Well-Woman Chart provides a list of all the preventive services recommendations for women from the WPSI, US Preventive Services Task Force, and Bright Futures.

The services are advised according to age groups and start at age 13 and end at 75 years with services categorized into general health, infectious disease, and cancer. The chart also has separate services listed for pregnancy and postpartum period.

Much has changed in the last 10 years to shift the focus of patients and practitioner when it comes to yearly well-women visit. The decade has seen a change in the recommendation about the frequency of yearly pap smears, growing popularity of long-acting reversible contraceptive methods and the mandate of performing the pelvic examination in every visit.

The recommendations also recognize that it may not be possible for the patient to complete all the services with one health care provider; hence a team-based approach will facilitate the completion of the services.

The practitioner should begin by a comprehensive medical, family, and reproductive history to individualize physical examination, immunization, and risk assessment. 

The decision to perform a breast and pelvic examination at each visit should be based on detailed family history, reproductive history, and shared decision making. The ACOG recent guidance recommends that pelvic and breast examinations be performed when indicated by medical history or symptoms.

The provider should also counsel the women about essential lifestyle choices and behaviors that have a detrimental effect on women’s’ health like smoking, alcohol, poor diet, and lack of exercise.  These factors also predispose women to high risk for cardiovascular diseases, gynecological cancers, and type 2 diabetes.

All women should be screened for obesity and overweight, and the opportunity should not be lost for counseling the women about maintaining ideal weight and exercising regularly. 

The provider should also discuss with reproductive age women about their reproductive life plan to ensure that all the immunizations are timely complete if planning a pregnancy. Matters like infertility and contraception should also be discussed as appropriate.

The authors further write that discussion about bone health, vulvovaginal symptoms, and sexual health are seldom done during the well-woman visit. The recommendations encourage discussing these issues based on the woman’s phase of life.

In all, an obstetrician and gynecologist should play a crucial role in providing primary and preventive care services to women of all ages.

Christopher Zahn, MD, ACOG vice president of Practice Activities, said in an ACOG news release, “Increasingly, women look to their ob-gyn for both reproductive and primary health care, which creates an exciting opportunity for ob-gyns to build even deeper and longer lasting relationships with our patients,” said Zahn.

“An ob-gyn may care for a patient as an adolescent, through her reproductive years, and as she experiences menopause and beyond. These resources are here to ensure that these ongoing updates to well-woman recommendations are manageable and positive for women’s health care providers and the women who are in their care,” he added further.

Committee opinion

Well-Woman Chart

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