Rec

omm

enda

tion

s fo

r W

ell-W

oman

Car

e –

A W

ell-W

oman

Cha

rt

©20

21, C

onte

nt o

wne

d by

the

ACO

G F

ound

atio

n, a

ll M

arks

and

Rig

hts

Rese

rved

. Thi

s pr

ojec

t was

sup

port

ed b

y th

e H

ealth

Res

ourc

es a

nd S

ervi

ces

Adm

inis

trat

ion

(HRS

A) o

f the

U.S

. Dep

artm

ent o

f Hea

lth a

nd H

uman

Ser

vice

s (H

HS)

und

er g

rant

num

ber U

HO

MC

2994

0, B

righ

t Fut

ures

for W

omen

’s H

ealth

: Sta

ndar

d Pr

actic

e G

uide

lines

for

Wel

l Wom

en C

are.

Thi

s in

form

atio

n or

con

tent

and

con

clus

ions

are

thos

e of

the

auth

or a

nd sh

ould

not

be

cons

true

d as

the

offic

ial p

ositi

on n

or p

olic

y of

, nor

shou

ld a

ny e

ndor

sem

ents

be

infe

rred

by

HRS

A, H

HS,

or t

he U

.S. G

over

nmen

t.

a Addi

tiona

l Bri

ght F

utur

es re

com

men

datio

ns in

clud

e: p

erio

dic

visi

on a

nd h

eari

ng te

sts

for a

ges

13-2

1; ri

sk a

sses

smen

t for

ane

mia

for a

ges

13-2

1; an

d flu

orid

e su

pple

men

tatio

n if

need

ed fo

r age

s 13

-16

(htt

ps://

dow

nloa

ds.a

ap.o

rg/A

AP/P

DF/

peri

odic

ity_s

ched

ule.

pdf)

b Imm

uniz

atio

ns sh

ould

be

adm

inis

tere

d ac

cord

ing

to th

e m

ost r

ecen

t AC

IP re

com

men

datio

ns (h

ttps

://w

ww

.cdc

.gov

/vac

cine

s/sc

hedu

les/

inde

x.ht

ml)

.

Abb

revi

atio

ns:

ACIP

= A

dvis

ory

Com

mitt

ee o

n Im

mun

izat

ion

Prac

tices

; BRC

A =

brea

st c

ance

r sus

cept

ibili

ty g

ene;

CRC

= c

olor

ecta

l can

cer;

CVD

= c

ardi

ovas

cula

r di

seas

e; H

IV =

hum

an im

mun

odefi

cien

cy v

irus

; HC

V =

hepa

titis

C v

irus

; HBV

= h

epat

itis

B vi

rus;

STI

= s

exua

lly tr

ansm

itted

infe

ctio

n; U

SPST

F =

U.S

. Pre

vent

ive

Serv

ices

Tas

k Fo

rce;

WPS

I = W

omen

’s P

reve

ntiv

e Se

rvic

es In

itiat

ive.

*Cri

teri

a fo

r se

lect

ive

use

1. Lo

w-d

ose

aspi

rin

to p

reve

nt c

ardi

ovas

cula

r dis

ease

and

col

orec

tal c

ance

r: C

alcu

late

d 10

-yea

r ris

k of

a C

VD e

vent

≥10

%; n

ot a

t inc

reas

ed ri

sk

for b

leed

ing;

hav

e a

life

expe

ctan

cy o

f at l

east

10 y

ears

; and

are

will

ing

to ta

ke lo

w-d

ose

aspi

rin

daily

for a

t lea

st 10

yea

rs.

2. D

iabe

tes

scre

enin

g an

d m

anag

emen

t: O

verw

eigh

t or o

bese

for a

ge 4

0-70

yea

rs; p

revi

ous

gest

atio

nal d

iabe

tes

but n

ot p

revi

ousl

y di

agno

sed

with

dia

bete

s m

ellit

us w

hen

not p

regn

ant f

or a

ge ≥

13 y

ears

.3.

Fol

ic a

cid

supp

lem

enta

tion:

Sex

ually

act

ive

and

plan

ning

or c

apab

le o

f pre

gnan

cy.

4. H

ealth

y di

et a

nd p

hysi

cal a

ctiv

ity c

ouns

elin

g: O

verw

eigh

t or o

bese

and

hav

e ad

ditio

nal C

VD ri

sk fa

ctor

s (h

yper

tens

ion,

dys

lipid

emia

, abn

orm

al

bloo

d gl

ucos

e le

vels

, dia

bete

s). S

peci

fic a

ntic

ipat

ory

guid

ance

for a

ges

13-1

7 m

ay b

e fo

und

in th

e Br

ight

Fut

ures

Gui

delin

es.

5. L

ipid

scr

eeni

ng: F

amili

al d

yslip

idem

ia, r

isk

fact

ors,

or h

igh-

risk

con

ditio

ns fo

r age

13-1

6 ye

ars;

uni

vers

al s

cree

ning

onc

e be

twee

n ag

e 17

-21 y

ears

; cl

inic

al ju

dgem

ent f

or a

ge 2

2-39

yea

rs.

6. O

steo

poro

sis

scre

enin

g: 10

-yea

r fra

ctur

e ri

sk e

quiv

alen

t to

an a

vera

ge-r

isk

65-y

ear o

ld w

oman

bas

ed o

n sp

ecifi

c ri

sk fa

ctor

s (p

aren

tal h

isto

ry

of h

ip fr

actu

re, s

mok

ing,

whi

te ra

ce, e

xces

s al

coho

l con

sum

ptio

n, lo

w b

ody

wei

ght)

.7.

Stat

in u

se to

pre

vent

CVD

: Ag

e 40

to 7

5 ye

ars;

one

or m

ore

CVD

risk

fact

ors

(i.e

., dy

slip

idem

ia, d

iabe

tes,

hyp

erte

nsio

n, o

r sm

okin

g);

and

calc

ulat

ed 10

-yea

r ris

k of

a C

VD e

vent

≥10

%.

8. U

rina

ry in

cont

inen

ce s

cree

ning

: Scr

een

all w

omen

age

18 a

nd o

lder

and

you

nger

wom

en if

pos

tpar

tum

.9.

Gon

orrh

ea a

nd c

hlam

ydia

scr

eeni

ng: N

ew s

ex p

artn

er, m

ore

than

one

sex

par

tner

, a s

ex p

artn

er w

ith c

oncu

rren

t par

tner

s, o

r a s

ex p

artn

er

who

has

an

STI;

inco

nsis

tent

con

dom

use

am

ong

pers

ons

who

are

not

in m

utua

lly m

onog

amou

s re

latio

nshi

ps; p

revi

ous

or c

oexi

stin

g ST

I; an

d ex

chan

ging

sex

for m

oney

or d

rugs

. Pre

vale

nce

is a

lso

high

er a

mon

g in

carc

erat

ed p

opul

atio

ns, m

ilita

ry re

crui

ts, a

nd p

atie

nts

rece

ivin

g ca

re a

t pub

lic S

TI c

linic

s.

10. H

epat

itis

B sc

reen

ing:

Bor

n in

a c

ount

ry w

ith a

pre

vale

nce

of H

BV in

fect

ion

≥2%

; lac

k of

vac

cina

tion

in in

fanc

y in

U.S

.-bor

n pe

rson

s w

ith

pare

nts

from

a c

ount

ry o

r reg

ion

with

pre

vale

nce

≥8%

; HIV

-pos

itive

per

sons

; inj

ectio

n dr

ug u

sers

; and

hou

seho

ld c

onta

cts o

r sex

ual p

artn

ers

of p

erso

ns w

ith H

BV in

fect

ion.

11. H

epat

itis

C s

cree

ning

: One

-tim

e sc

reen

ing

for a

sym

ptom

atic

adu

lts a

ge 18

to 7

9 w

ithou

t kno

wn

liver

dis

ease

. Re

peat

scre

enin

g an

d sc

reen

at o

ther

ag

es if

pas

t or c

urre

nt in

ject

ion

drug

use

.12

. HIV

pre

expo

sure

pro

phyl

axis

(PrE

P): C

andi

date

s fo

r inc

lude

1) h

eter

osex

ually

act

ive

wom

en w

ith a

ser

odis

cord

ant s

ex p

artn

er (i

.e.,

in a

sex

ual

rela

tions

hip

with

a p

artn

er li

ving

with

HIV

); or

inco

nsis

tent

use

of c

ondo

ms

duri

ng s

ex w

ith a

par

tner

who

se H

IV s

tatu

s is

unk

now

n an

d w

ho is

at

hig

h ri

sk; o

r an

STI w

ith s

yphi

lis o

r gon

orrh

ea w

ithin

the

past

6 m

onth

s; 2

) use

s in

ject

ion

drug

s an

d sh

ared

use

of d

rug

inje

ctio

n eq

uipm

ent;

or h

as ri

sk o

f sex

ual a

cqui

sitio

n of

HIV

bas

ed o

n ab

ove;

3) e

ngag

ed in

tran

sact

iona

l sex

, suc

h as

for m

oney

, dru

gs, o

r oth

er.

13. S

exua

lly tr

ansm

itted

infe

ctio

n pr

even

tion

coun

selin

g: R

isk

fact

ors

for S

TIs

incl

ude

havi

ng a

n ST

I cur

rent

ly o

r with

in th

e pa

st y

ear,

not

cons

iste

ntly

usi

ng c

ondo

ms,

hav

ing

mul

tiple

sex

par

tner

s, o

r hav

ing

sex

part

ners

with

in p

opul

atio

ns w

ith a

hig

h pr

eval

ence

of S

TIs.

Incr

ease

d ST

I pre

vale

nce

rate

s ar

e fo

und

amon

g w

omen

see

king

STI

test

ing

or a

tten

ding

STI

clin

ics;

sex

ual a

nd g

ende

r min

oriti

es; a

nd a

mon

g th

ose

with

H

IV, u

sing

inje

ctio

n dr

ugs,

exc

hang

ing

sex

for m

oney

or d

rugs

, or r

esid

ing

in c

orre

ctio

nal f

acili

ties.

14

. Syp

hilis

scr

eeni

ng: W

omen

with

HIV

; hig

h pr

eval

ence

com

mun

ities

or p

opul

atio

ns; h

isto

ry o

f inc

arce

ratio

n; e

xcha

ngin

g se

x fo

r mon

ey o

r dru

gs.

15. T

uber

culo

sis

infe

ctio

n: P

erso

ns fr

om c

ount

ries

with

incr

ease

d tu

berc

ulos

is p

reva

lenc

e; li

ving

in h

igh-

risk

con

greg

ate

sett

ings

(e.g

., ho

mel

ess

shel

ters

, cor

rect

iona

l fac

ilitie

s); e

xpos

ure

to in

divi

dual

s w

ith a

ctiv

e tu

berc

ulos

is, s

uch

as h

ealth

car

e w

orke

rs a

nd w

orke

rs in

hig

h-ri

sk

cong

rega

te s

ettin

gs; i

mm

unos

uppr

esse

d in

divi

dual

s.16

. Bre

ast c

ance

r scr

eeni

ng: N

o sp

ecifi

c cr

iteria

, dec

isio

ns a

bout

scre

enin

g ar

e m

ade

on a

n in

divi

dual

bas

is th

roug

h a

shar

ed-d

ecis

ion

mak

ing

proc

ess.

17. L

ung

canc

er s

cree

ning

: 30

pack

-yea

r sm

okin

g hi

stor

y an

d cu

rren

tly s

mok

e or

hav

e qu

it w

ithin

the

past

15 y

ears

.18

. Med

icat

ions

to re

duce

bre

ast c

ance

r ris

k: M

ajor

risk

fact

ors

for b

reas

t can

cer i

nclu

de in

crea

sing

age

, fam

ily h

isto

ry o

f bre

ast o

r ova

rian

can

cer

(esp

ecia

lly a

mon

g fir

st-d

egre

e re

lativ

es a

nd o

nset

bef

ore

age

50 y

ears

), hi

stor

y of

aty

pica

l hyp

erpl

asia

or o

ther

non

mal

igna

nt h

igh-

risk

bre

ast

lesi

ons,

pre

viou

s br

east

bio

psy,

and

ext

rem

ely

dens

e br

east

tiss

ue. M

odel

s su

gges

t tha

t wom

en w

ith a

n es

timat

ed 5

-yea

r bre

ast c

ance

r ris

k of

3%

or g

reat

er a

re li

kely

to h

ave

mor

e be

nefit

than

har

m, a

lthou

gh th

e ba

lanc

e of

ben

efits

and

har

ms

depe

nds

on a

ge, r

ace

or e

thni

city

, the

m

edic

atio

n us

ed, a

nd w

heth

er th

e pa

tient

has

a u

teru

s.19

. Ski

n ca

ncer

cou

nsel

ing:

Fai

r ski

n, li

ght h

air a

nd e

ye c

olor

, fre

ckle

s, s

unbu

rn e

asily

.20

. Per

inat

al d

epre

ssio

n pr

even

tive

inte

rven

tions

: Cou

nsel

ing

inte

rven

tions

for w

omen

with

one

or m

ore

of th

e fo

llow

ing:

a h

isto

ry o

f dep

ress

ion,

cu

rren

t dep

ress

ive

sym

ptom

s tha

t may

not

reac

h a

diag

nost

ic th

resh

old,

soci

oeco

nom

ic ri

sk fa

ctor

s suc

h as

low

inco

me

or a

dole

scen

t or s

ingl

e pa

rent

hood

, rec

ent i

ntim

ate

part

ner v

iole

nce,

or m

enta

l hea

lth–r

elat

ed fa

ctor

s suc

h as

ele

vate

d an

xiet

y sy

mpt

oms o

r a h

isto

ry o

f sig

nific

ant

nega

tive

life

even

ts.

21. P

reec

lam

psia

pre

vent

ion

with

low

-dos

e as

pirin

: His

tory

of p

reec

lam

psia

, esp

ecia

lly w

hen

acco

mpa

nied

by

an a

dver

se o

utco

me;

mul

tifet

al g

esta

tion;

ch

roni

c hy

pert

ensi

on; t

ype

1 or 2

dia

bete

s mel

litus

; ren

al d

isea

se; a

utoi

mm

une

dise

ase

(sys

tem

ic lu

pus e

ryth

emat

ous,

antip

hosp

holip

id sy

ndro

me)

.22

. Dia

bete

s sc

reen

ing

afte

r pre

gnan

cy: P

revi

ous

gest

atio

nal d

iabe

tes

but n

ot p

revi

ousl

y di

agno

sed

with

dia

bete

s m

ellit

us w

hen

not p

regn

ant.

PREVENTION SERVICESAGE (Years)

13 –17a 18–21a 22–39 40–49 50–64 65–75 >75 GENERAL HEALTH

Alcohol use screening & counseling Anxiety screening

CVD & CRC prevention with aspirin1 50-59 Blood pressure screening Contraceptive counseling & methods Depression screening Diabetes screening2

Fall prevention

Folic acid supplementation3

Healthy diet & activity counseling4

Interpersonal & domestic violence screening

Lipid screening5

Obesity screening & counseling Osteoporosis screening6

Statin use to prevent CVD7

Substance use screening & assessment Tobacco screening & counseling Urinary incontinence screening8

INFECTIOUS DISEASES

Gonorrhea & chlamydia screening9 ≤24 >24Hepatitis B screening10

Hepatitis C screening (at least once)11 <80HIV preexposure prophylaxis12

HIV risk assessmentHIV screening (at least once) >15Immunizationsb

STI prevention counseling13

Syphilis screening14

Tuberculosis screening15

CANCER

Breast cancer screening16

Cervical cancer screening ≥21 ≤65Colorectal cancer screeningLung cancer screening17 55-80 55-80Medications to reduce breast cancer risk18

Risk assessment for BRCA 1/2 testingSkin cancer counseling19 ≤24

PREVENTION SERVICESfor pregnancy provided in addition to age-based services listed above.

PREGNANCYAnxiety screening

Bacteriuria screeningBreastfeeding counseling, services & suppliesContraceptive counseling & methodsDepression screening & preventive interventions20

Folic acid supplementationGestational diabetes screeningGonorrhea & chlamydia screeningHepatitis B screeningHIV screening (each pregnancy)Interpersonal & domestic violence screeningPreeclampsia prevention with low-dose aspirin21

Preeclampsia screeningRh(D) blood typingSubstance use screening & assessment

Syphilis screeningTobacco screening & counseling

PREVENTION SERVICESfor postpartum provided in addition to age-based services listed above.

POSTPARTUMAnxiety screening

Breastfeeding counseling, services & suppliesContraceptive counseling & methodsDepression screening & preventive interventions20

Diabetes screening after gestational diabetes22

Folic acid supplementationInterpersonal & domestic violence screeningSubstance use screening & assessment

Tobacco screening & counseling

KEY: Recommended by the USPSTF (A or B rating), WPSI, or Bright Futures Recommended for selected use

Preventive care visits provide an excellent opportunity for well-woman care including screening, evaluation of health risks and needs, counseling, and immunizations. Recommendations for Well-Woman Care – A Well-Woman Chart was developed by the Women’s Preventive Services Initiative (WPSI). The Well-Woman Chart outlines preventive services recommended by the WPSI, U.S. Preventive Services Task Force (USPSTF), and Bright Futures based on age, health status, and risk factors. Additional recommendations for immunizations are provided in a separate table from the Advisory Committee on Immunization Practices. Clinical practice considerations, risk assessment methods, and the age and frequency to deliver services are described in the Clinical Summary Tables that accompany the chart.

The Well-Woman Chart provides a framework for incorporating preventive health services for women into clinical practice. These services may be completed at a single visit or as part of a series of visits that take place over time. This information is designed as an educational resource to aid clinicians in providing preventive health services for women, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. While every effort is made to present accurate and reliable information, this publication is provided “as is” without any guarantees or warranties of accuracy, reliability, or otherwise, either express or implied. The Chart and Tables are updated annually. The WPSI website (www.womenspreventivehealth.org) has the most up-to-date version of the Chart and Clinical Summary Tables.

Recommendations from the WPSI and the USPSTF for preventive services for pregnant and postpartum women are also provided in the Well-Woman Chart. Comprehensive recommendations for pregnant and postpartum women can be found in ACOG’s practice guidelines and other educational materials.

2021 RECOMMENDATIONS FOR WELL-WOMAN CARE

MEMBERS OF THE ADVISORY PANEL SUPPORT THE WPSI

Copyright © 2021 by the ACOG Foundation, updated January 2021