The well-woman visit is one of the most tested topics on the FNP boards because it's the cornerstone of primary care for adult female patients. The exam will give you a woman of a specific age and ask what screening is due. If you don't know the age-based recommendations cold, you'll lose points unnecessarily.
Here's the clean breakdown.
Well-woman care is age-based. Learn the ages and the rest falls into place.
Cervical Cancer Screening (Pap Smear)
Per current ACS/USPSTF guidelines:
- Under 21: No screening, regardless of sexual activity.
- 21 to 29: Pap every 3 years (cytology alone). No HPV testing routinely.
- 30 to 65: Pap with HPV co-testing every 5 years (preferred), OR Pap alone every 3 years, OR HPV alone every 5 years.
- Over 65: Stop screening if adequate prior negative screening (3 negatives or 2 negative co-tests within 10 years).
- Post-hysterectomy with cervix removed for benign reasons: No screening.
Breast Cancer Screening
Multiple guidelines exist. The exam tends to follow USPSTF most often:
- 40 to 49: Individual decision based on risk. Biennial mammogram for women who choose to start.
- 50 to 74: Biennial mammogram.
- 75+: Insufficient evidence to recommend for or against.
The ACS recommends annual starting at 45. The ACOG recommends starting at 40. If a question references a specific organization, follow that one's age. If general, USPSTF is the safest default.
Colorectal Cancer Screening
USPSTF now recommends screening starting at age 45, continuing to 75. Options include:
- Colonoscopy every 10 years
- FIT (fecal immunochemical test) annually
- FIT-DNA (Cologuard) every 1–3 years
- Flexible sigmoidoscopy every 5 years
- CT colonography every 5 years
Bone Density Screening
- Women 65+: DEXA scan. Repeat every 2 years if normal.
- Postmenopausal women under 65 with risk factors: Earlier screening.
Lung Cancer Screening
- Annual low-dose CT for adults 50 to 80 with a 20+ pack-year smoking history who currently smoke or quit within 15 years.
Lipid Screening
- Every 4–6 years starting at age 20 for low-risk adults.
- More frequently in higher-risk adults.
Diabetes Screening
- Adults 35 to 70 who are overweight or obese — screen every 3 years.
- Earlier and more frequently in higher-risk patients.
Test Pearl: When a question describes a patient and asks "what screening is due?" — calculate the age and rule down the list. The exam rewards systematic.
Immunizations for Adult Women
- Tdap: Once in adulthood (then Td booster every 10 years). Tdap with each pregnancy at 27–36 weeks.
- Influenza: Annually.
- HPV: Through age 26 (catch-up to 45 in select cases).
- MMR: Check rubella status in women of childbearing age. Do NOT give in pregnancy.
- Varicella: Check immunity. Do NOT give in pregnancy.
- Pneumococcal: All adults 65+.
- Shingrix: Adults 50+, two-dose series.
- COVID: Per current CDC guidance.
Reproductive Health Topics
- Contraceptive counseling at every visit if pregnancy is a possibility.
- Preconception counseling for women considering pregnancy — folic acid 400–800 mcg daily.
- STI screening: annual chlamydia and gonorrhea in sexually active women under 25; HIV at least once for all adults; syphilis if at risk.
Mental Health Screening
- Depression screening (PHQ-2, PHQ-9) annually in all adults.
- Intimate partner violence screening — annually for women of reproductive age.
The Strategy
When the exam describes a 52-year-old woman coming in for a well-visit, in your head: age 52, average risk. Due for mammogram (every 2 years), colorectal screening, Pap every 3 or 5 years depending on method, depression screen, lipid panel within last 5 years, diabetes screen if overweight, Tdap if not within 10 years.
Build this checklist for the ages 25, 35, 45, 55, 65, 75. Six lists. That's the entire well-woman section of the exam, distilled.