Women's Health in a DPC Practice (Screening, Contraception, Menopause and When to Refer)

What women's health services can a DPC practice offer?

A direct primary care practice can offer well-woman visits, cervical screening, mammogram ordering and follow-up, contraception including long-acting methods, menopause care and, for trained clinicians, perinatal care. The limits come from each clinician's training, the state's practice and telehealth rules, the malpractice policy and, for HSA members, the federal definition of what a DPC membership can include. A survey in a 2020 report gives numbers for some related services: 91% of DPC physicians said obstetrical services were not available, and 82% said colposcopy was not. We found no numbers specific to the others, so nothing else here describes what is typical.

This guide is written for physicians, nurse practitioners and owners deciding what to build into a practice, and it is not medical advice for patients or legal advice. Every clinical schedule below links to the body that sets it, and each was current when we checked those pages on November 5, 2026. These bodies do not always agree, and several of the areas covered here are moving, so read the source before you change a protocol.

What should a well-woman visit include?

The Women's Preventive Services Initiative, whose guidelines HRSA supports, recommends at least one preventive care visit per year from adolescence onward. Its stated purpose is to deliver and coordinate recommended preventive services by age and risk, and those services can be spread over a series of visits rather than packed into one. That framing suits a membership practice that offers longer appointments and direct messaging, since a clinician can split the work across the year.

HRSA's guideline list names more than the screening tests people expect. It includes screening for anxiety in adolescent and adult women, including during pregnancy and postpartum, at least annual screening for intimate partner and domestic violence, counseling on sexually transmitted infections for those at increased risk, and patient navigation for breast and cervical screening. For the wider adult schedule, see our guide to annual physicals and preventive care in a DPC, and for what happens after a positive anxiety or depression screen, see mental health care in a DPC.

What are the cervical cancer screening guidelines for 2027?

Three national sources matter here, and they are at different points in being updated. The USPSTF's final recommendation dates from 2018, and its page says the topic is being updated. HRSA adopted a newer guideline that governs coverage for plan years starting in 2027. ACOG replaced its 2021 advisory in July 2026 with a statement that endorses HRSA's guideline with qualifications.

ACOG departs from HRSA on self-collection. It sets a 3-year interval for patient-collected testing, saying data supporting 5 years are lacking, and says to use it only if the patient prefers it and notification, documentation and follow-up processes are in place. It also notes that the currently available patient-collected tests are approved solely for samples ordered or approved by a clinician for patients aged 25 to 65. Read the full statement before you write a self-collection protocol.

Who should not be screened on the routine schedule?

The USPSTF recommends against screening patients younger than 21, those who have had a hysterectomy with removal of the cervix and have no history of a high-grade precancerous lesion or cervical cancer, and those older than 65 with adequate prior screening who are not otherwise at high risk. HRSA's implementation notes define adequate prior screening as three consecutive negative cytology results or two consecutive negative cotests within the previous 10 years, with the most recent in the past 5 years. Those notes are informational and not part of the formal guideline.

Both sources set patients at higher risk apart. The HRSA notes say the recommendations do not apply to patients with HIV, immunocompromised patients, those exposed to diethylstilbestrol in utero, or those treated for CIN 2 or higher in the past 20 years.

Can a DPC offer self-collected HPV testing?

The FDA approved HPV tests allowing self-collection in a health care setting in 2024, according to the National Cancer Institute, and Reuters reported the first at-home approval in May 2025. HRSA's notes say the choice between clinician and patient collection should come from shared decision-making and be consistent with FDA-approved methods. Before offering it, confirm that your reference lab accepts the collection method you plan to use and that you have a clear path for a positive result, which HRSA notes may mean further testing such as cytology, colposcopy or biopsy.

Abnormal results are managed under the ASCCP risk-based management guidelines, which HRSA's update leaves outside its own scope, and ACOG also points to the later Enduring Consensus guidelines. If colposcopy is not something you do in the office, line up that referral before the first abnormal result arrives.

When should breast cancer screening start?

All three sources allow screening from age 40 at average risk, while differing on how firmly to start, how often to repeat and when to stop.

The USPSTF also issued an I statement, meaning the evidence is insufficient, on what more should be done for patients with dense breasts. It is a question patients may raise, because the FDA's amended mammography rule has required facilities to include breast density notification since enforcement began on September 10, 2024.

ACOG lists family history of breast, ovarian or other inherited cancers, BRCA1 and BRCA2 mutations, chest radiation at a young age and high-risk biopsy results as markers of higher risk. The USPSTF schedule still covers patients with a first-degree relative with breast cancer or with dense breasts. It does not cover a genetic marker or syndrome such as BRCA1 or BRCA2, high-dose chest radiation at a young age, previous breast cancer or a high-risk lesion on biopsy, so those patients call for an individual plan or a referral. For the imaging itself, our guide to cash-price imaging covers how DPC practices can order it for members.

Can a DPC provide contraception and LARC?

Contraceptive counseling and prescribing fit within primary care, and CDC publishes the two references to work from. The U.S. Selected Practice Recommendations for Contraceptive Use, 2024 covers how to start and manage each method, including intrauterine contraception and implants, and the U.S. Medical Eligibility Criteria, 2024 covers who can safely use which method. Separately, the FDA approved the first nonprescription daily oral contraceptive in 2023, so some patients will arrive already using one.

Offering LARC takes more planning than prescribing a pill. The etonogestrel implant's labeling carries a boxed warning on improper insertion and removal and says it is available only through a restricted FDA safety program (a REMS). Clinicians must enroll, complete training and be certified before first use, and the pharmacies and distributors that supply it must be certified or registered in the same program, so finish certification before you plan to stock it. ACOG says clinicians already trained and actively inserting have until February 27, 2027 to certify. For IUDs, confirm your training and current competence, your malpractice coverage for the procedure, how you will source and store devices, and who handles a difficult insertion or a lost string. HRSA's guideline treats removal and follow-up as part of contraceptive care, so promise only what you can see through to the end.

A wet mount or KOH prep during a gynecologic visit brings in lab rules. CMS lists wet mounts, KOH preparations and fern tests as provider-performed microscopy, so check that your CLIA certificate covers them. Our guide to dispensing medications and labs covers the rest of that setup.

Does putting an IUD in the membership affect HSA eligibility?

It might, and this is worth settling before you print a fee schedule. The law behind IRS Notice 2026-5 excludes from a qualifying arrangement's primary care services any prescription drugs other than vaccines, along with procedures requiring general anesthesia and certain lab services. We searched the notice and it never mentions contraceptives, IUDs or implants, so it does not resolve how each method is treated. The notice also limits separate billing for care that comes with the membership, while allowing services sold separately to members and non-members alike. Take the question to a tax adviser, and see our HSA rules guide for the wider picture.

Does insurance have to cover women's preventive services?

HRSA explains that under section 2713 of the Public Health Service Act, most health plans must cover listed preventive services without a copayment, coinsurance or deductible. In June 2025, in Kennedy v. Braidwood Management, the Supreme Court upheld the USPSTF part of that requirement by a 6-3 vote.

The requirement speaks to plans, and that shapes how it reaches a DPC patient in three ways.

• Networks. Under 45 CFR 147.130, a plan with a network need not pay for out-of-network preventive services and may apply cost sharing to them, unless it has no in-network provider who can deliver the service. A patient's free screening may depend on where you send the order.
• Follow-up testing. HRSA's guidelines now say that additional imaging and pathology for breast screening, and testing such as colposcopy and biopsy for cervical screening, are recommended, when indicated, to complete the screening process. The cervical language takes effect with plan years starting in 2027, so ask the plan how it applies this to a specific patient.
• Contraception. HRSA's guideline covers the full range of FDA-approved, -granted or -cleared contraceptives along with related care. The federal religious and moral exemption rules have been in litigation, and Bloomberg Law reported that a federal court in Pennsylvania vacated them in August 2025. A Third Circuit panel heard arguments in the appeal in July 2026, and we found no decision as of our November 5, 2026 check, so verify before relying on it.

A membership does not replace this coverage, so members need the right insurance behind it, and our guide on what insurance to pair with DPC walks through the options.

Can a family doctor in a DPC provide prenatal and perinatal care?

Training decides this more than the practice model does. The American Academy of Family Physicians calls pregnancy, perinatal and newborn care a core discipline of family medicine, with a scope that can range from preconception care through cesarean delivery, and it holds that privileges should rest on training, experience and demonstrated competence. The older numbers we found on how many family physicians do this work show a decline. Research summarized by the American Board of Family Medicine found that the share reporting maternity care fell from 23.3% in 2000 to 9.7% in 2010. More recent data on early-career family physicians show the share delivering babies fell from 13.1% in 2016 to 10.8% in 2024, while the share providing maternity care rose from 25.0% to 28.9%. In a survey of DPC physicians in a 2020 Society of Actuaries report, 91% said obstetrical services were not available in their practice, and in a smaller survey published in 2017, 1 of 38 respondents provided obstetrical care.

Even a practice that leaves deliveries to others can do real perinatal work, within its scope and malpractice coverage. That can include preconception visits and these two USPSTF recommendations.

• Low-dose aspirin, 81 mg a day, after 12 weeks of gestation for patients at high risk of preeclampsia (grade B).
• Providing or referring to counseling for pregnant and postpartum patients at increased risk of perinatal depression (grade B, February 2019; the USPSTF lists this topic as being updated).

Be clear in your membership agreement about who manages the pregnancy and who a patient calls at 2 AM with bleeding, and name the obstetric practice and hospital you refer to. A membership does not pay for a delivery, so a pregnant member needs insurance that does.

What can a DPC do for menopause care?

Perimenopause and menopause suit a practice with time for longer conversations, and the prescribing information has recently shifted. On February 12, 2026, the FDA approved labeling changes for six menopausal hormone therapy products, removing risk statements on cardiovascular disease, breast cancer and probable dementia from the boxed warning. The agency said 29 companies had submitted proposed changes and that this was the first batch, so read the current label for the specific product rather than assuming every label has changed.

The Menopause Society's 2022 position statement says that for patients younger than 60 or within 10 years of menopause onset, with no contraindications, the benefit-risk ratio is favorable for bothersome vasomotor symptoms and prevention of bone loss. It predates the labeling change, so check whether the society has updated it since our review.

What rules apply to telehealth prescribing in women's health?

Telehealth prescribing for women's health runs through three separate questions, which are whether you are licensed where the patient is, what the state board requires, and whether the drug has its own federal or state rules. Our guide to telehealth prescribing rules for 2027 covers licensure and the DEA in depth, and our credentialing checklist covers the licenses themselves.

Testosterone is on the federal Schedule III list, so it falls under the DEA's telemedicine flexibilities, which run through December 31, 2026. Check the telehealth guide above for the latest on what follows.

Where does mifepristone stand legally?

This is contested, and we take no position on it. What follows is the status as reported by the sources cited, on our November 5, 2026 check. It can change quickly, so confirm it with counsel.

• Federal rules. KFF's factsheet, updated May 14, 2026, says that FDA's safety program requires prescribers to be certified by the manufacturer, and that since the 2023 changes the drug can be prescribed by telehealth and dispensed by mail or at certified pharmacies.
• Courts. On May 14, 2026, the Supreme Court blocked a Fifth Circuit order in Louisiana v. FDA that would have restored in-person dispensing, leaving current rules in place while the litigation continues. A Fifth Circuit panel heard arguments in September 2026, and we found no ruling from it as of our check.
• FDA review. The FDA told the court in an October 7 status report that it expects study results by mid-December 2026 and its report on them no later than March 2027. Its separate review of the drug's safety program has no completion date in the filing, any decision on changes comes after both, and the FDA says it expects to update its estimate around March 2027.
• State law. That factsheet says state abortion bans apply to medication abortion, and that among states without a ban, ten have at least one restriction requiring a clinic trip. A July 2026 KFF report counts 22 states and Washington, D.C., with shield laws intended to reduce legal risk for clinicians, 8 of those states with explicit protections regardless of where the patient is, and details vary by state.

Whether this falls within a given practice's services is that practice's decision, and it should be made with health care counsel and your malpractice carrier, using the law of both the state you practice in and the state where the patient is located.

When should a DPC refer women's health patients?

The sources above draw several of these lines themselves, and the rest come down to your training and your equipment. Write them into your protocols in advance.

For more on building those relationships, see our guide to specialist access in a DPC.

How do you keep screening and follow-up from slipping?

Screening only helps when the result reaches someone and the next step happens, and the intervals here are long enough to make that hard. A 3-year or 5-year HPV recall, depending on the collection method and the guideline you follow, a 2-year mammogram and an abnormal result awaiting colposcopy can each live in a different tool, which is a problem with how those systems were built and not with the people using them. HRSA's list even recognizes the gap, since it recommends patient navigation for breast and cervical screening and follow-up.

Three habits help whichever software you run. Record the method and next due date for each screening so a recall matches the patient's actual schedule, keep an abnormal result open until the next step is complete, and make a referral count as finished only when the report is back, the ordering clinician has reviewed it and the patient knows what happens next. Our guide to specialist referral tracking goes through that last step.

This is also where Tabflows can help, as a dedicated tech team that connects the EHR, billing and messaging tools a clinic already uses, so results, tasks and patient context sit in one place and the follow-ups get done. It is not an EHR and it makes no clinical decisions, and the screening decisions stay with you and the sources above.

If you are still deciding what your practice will offer, our guide to starting a DPC is a good next read, along with how the state rules on DPC differ.