The Well-Woman Check-up: A Complete Guide

In France, annual gynaecological check-ups are a normal part of women’s preventive healthcare. From their teenage years, French women see a gynaecologist regularly — it is culturally embedded, practically universal, and covered by the healthcare system. The consultation typically includes a full pelvic examination, breast check, cervical smear, and a discussion about contraception and sexual health. It is proactive, thorough, and entirely unremarkable.

In the UK, the approach is fundamentally different. There is no routine annual gynaecological examination. Women are invited for cervical screening every three to five years depending on their age, and mammography starts at 50 through the NHS Breast Screening Programme. Beyond these specific screens, there is no systematic check-up — you see a gynaecologist only when something goes wrong, or when your GP refers you for a specific concern. Many women go years, sometimes decades, without a comprehensive gynaecological assessment.

Having trained and practised in both systems, I see the gaps clearly. The French model catches things early. The UK model is excellent at treating problems once they arise, but less good at prevention. A well-woman check-up is designed to bridge that gap — offering a comprehensive assessment of your gynaecological and general health even when you feel perfectly well.

What does a well-woman check-up include?

A thorough well-woman appointment typically covers:

• Medical history review: A discussion of your menstrual cycle, contraception, sexual health, family history, and any symptoms you may have been dismissing
• Cervical screening: A smear test if you are due or overdue
• Breast examination: A clinical examination with guidance on self-awareness
• Pelvic ultrasound: An assessment of the uterus and ovaries to check for fibroids, cysts, or other findings
• Blood tests: Depending on your age and risk factors, this may include a full blood count, thyroid function, vitamin D, hormonal profile, or metabolic screening
• Sexual health screening: If appropriate or requested

What happens during each part

Breast examination: I perform a careful clinical examination of both breasts and the axillary lymph nodes. I am feeling for lumps, areas of thickening, skin changes, and asymmetry. This takes a few minutes and is not painful. Equally valuable is the conversation that accompanies it — I teach each patient what to look for at home, because breast awareness between appointments is just as valuable as the examination itself.

Pelvic examination and ultrasound: A transvaginal ultrasound gives me a detailed view of the uterus, endometrium, and ovaries. I can identify fibroids (and measure their size and location), ovarian cysts, endometrial polyps, and signs of adenomyosis or endometriosis. Many women are surprised by how much information a simple ultrasound can provide. In my experience, this is often the most clinically valuable part of the check-up — I regularly pick up findings that have been silently developing for years.

Cervical screening: If you are due, I perform a smear test during the same appointment. The sample is tested for high-risk HPV first, and if positive, the cells are examined for abnormalities. For women who find smears uncomfortable or anxiety-provoking, doing it in a calm, unhurried setting with a specialist can make a real difference.

Blood tests: I tailor the blood panel to each patient, but there are several tests I consider routinely. A full blood count checks for anaemia — common in women with heavy periods. Thyroid function (TSH and free T4) is important because thyroid disorders affect roughly 1 in 20 women and can cause fatigue, weight changes, irregular periods, and mood disturbance. I check vitamin D, which is deficient in a striking proportion of women living in the UK, particularly those with darker skin or limited sun exposure. Ferritin — your iron stores — is distinct from haemoglobin and can be depleted long before you become formally anaemic, causing exhaustion that is often attributed to being busy or stressed. Depending on your age and symptoms, I may add a hormonal profile (FSH, LH, oestradiol, AMH) or metabolic markers including fasting glucose, HbA1c, and lipids.

Recommendations by age

In your 20s: Cervical screening begins at 25 in the UK. This is also a good time to review contraception, ensure HPV vaccination is complete, and discuss STI screening. A baseline well-woman check can establish what is normal for you — your cycle pattern, your ovarian anatomy, your hormonal balance — which becomes invaluable for comparison later.

In your 30s: Many women begin thinking about fertility in their thirties, and a well-woman check can include an assessment of ovarian reserve (AMH blood test and antral follicle count on ultrasound). This is also the decade when conditions like endometriosis and fibroids often become symptomatic. I see many women in this age group who have been tolerating heavy or painful periods for years without investigation.

In your 40s: Perimenopause can begin in the early-to-mid forties, and symptoms are frequently misattributed to stress or lifestyle. A hormonal assessment, combined with a detailed symptom history, can clarify whether hormonal changes are playing a role. Screening for metabolic risk — cholesterol, blood sugar, blood pressure — becomes increasingly relevant. Fibroids tend to grow in the years before menopause, so ultrasound monitoring is particularly useful.

50s and beyond: Post-menopausal health requires attention to bone density (a DEXA scan may be indicated), cardiovascular risk, and any post-menopausal bleeding, which always warrants investigation. Women on HRT benefit from annual review to ensure their regimen remains appropriate. Breast screening via mammography is offered every three years through the NHS from age 50, but clinical breast examination in between can add an extra layer of reassurance.

When to book outside routine screening

You do not need to wait for your next scheduled smear or mammogram. I would recommend booking a well-woman check-up if:

• You have noticed a change in your periods — heavier, more painful, more irregular, or absent
• You are experiencing persistent pelvic pain, bloating, or pressure symptoms
• You are planning a pregnancy and want to optimise your health beforehand
• You have a family history of ovarian, breast, or endometrial cancer
• You are approaching or going through menopause and want guidance
• You simply have not had a thorough gynaecological assessment in a long time

Why is preventive care valuable?

Many gynaecological conditions develop gradually and may not cause obvious symptoms in their early stages. Ovarian cysts, endometrial changes, early fibroids, and hormonal imbalances can all be identified on a routine check before they become problematic. Catching these early means simpler management and better outcomes. I have lost count of the number of times a routine ultrasound has revealed a fibroid or ovarian cyst that a patient had no idea was there.

Beyond the physical findings, a well-woman appointment is also an opportunity to ask all the questions you have been putting off — about your cycle, your contraception, your sexual health, your family planning, or any changes you have noticed. In my experience, the conversation is often just as valuable as the examination.