Primary Care and Women's Health Across the Lifespan
Primary Care and Women's Health Across the Lifespan
This domain tests preventive screening, contraception, STI care, menopause management, and mental health. Items often ask who should be screened and which method fits the patient.
Core rules
- Cervical cancer screening: start at 21. Ages 21-29: cytology every 3 years. Ages 30-65: cytology every 3 years, co-test every 5 years, or primary HPV every 5 years. Stop after 65 with adequate negative prior screening.
- Mammography: USPSTF recommends biennial screening ages 40-74.
- Contraception: use CDC US MEC. LARC is first-line. Estrogen-containing methods are contraindicated with migraine with aura, smoking at age ≥35, hypertension, VTE history, or breast cancer.
- Postpartum: avoid estrogen-containing methods for 21 days; extend to 6 weeks with breastfeeding plus VTE risk.
- STI: annual chlamydia and gonorrhea screening for sexually active patients <25 and older patients at risk; HIV screening once ages 15-65; syphilis screening in pregnancy.
- Menopause: hormone therapy for vasomotor symptoms at lowest effective dose, generally within 10 years of menopause, after individualized risk assessment.
Worked example
A 52-year-old with migraine with aura requests combined oral contraceptives. The aura makes estrogen contraindicated because of stroke risk. Offer progestin-only pills, a levonorgestrel IUD, an etonogestrel implant, or a copper IUD. Reasoning: use the MEC category, not patient preference alone, and document counseling.
Traps
Screening before 21; continuing cytology every year; missing postpartum estrogen timing; prescribing combined oral contraceptives with aura; using hormone therapy for prevention rather than symptoms.