Category: Women’s Health

  • Introducing the Ziwig Endotest: A Revolutionary Saliva Test for Early Endometriosis Detection

    Introducing the Ziwig Endotest: A Revolutionary Saliva Test for Early Endometriosis Detection

    Endometriosis is a painful, often life-disrupting condition affecting millions of women worldwide. Despite its prevalence, diagnosis can take years — with the average delay currently over 8 years and 10 months.

    Traditionally, the only definitive way to diagnose endometriosis was through laparoscopy, a surgical procedure under general anaesthetic. But today, a groundbreaking innovation is transforming that reality.

    At Coyne Medical, we are proud to offer the Ziwig Endotest — a non-invasive, saliva-based test developed in France that enables the early detection of endometriosis without the need for surgery. Validated in large-scale clinical trials, with results published in the New England Journal of Medicine in 2023, this test is helping women access faster, safer diagnosis and timely treatment.

    🤍 Understanding Endometriosis: Symptoms, Challenges & the Need for Early Diagnosis

    Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus (womb), often causing:

    • Chronic pelvic pain
    • Heavy or painful periods (dysmenorrhoea)
    • Pain during intercourse (dyspareunia)
    • Digestive symptoms
    • Infertility

    Around 1 in 10 women of reproductive age in the UK are affected, but symptoms often overlap with conditions like IBS (irritable bowel syndrome) or pelvic inflammatory disease, making diagnosis difficult.

    Nearly half of women report 10 or more GP visits before receiving a diagnosis.

    Standard tests such as blood tests, hormone levels, ultrasound, or MRI can often appear normal — leaving patients feeling unheard or doubting their symptoms. The current reliance on laparoscopy delays care and can impact fertility, quality of life, and mental wellbeing.

    🔬 How the Ziwig Endotest® Is Transforming Diagnosis with Non-Invasive Technology

    The Ziwig Endotest® offers a powerful alternative to traditional diagnostic tools:

    • Saliva-based, non-invasive
    • No anaesthetic, no surgery
    • Minimal preparation
    • Results within 3–4 weeks

    In studies across France, the test achieved:

    • 97% sensitivity (correctly identifies 97 out of 100 people with endometriosis)
    • 93% specificity (accurately rules out endometriosis when it’s not present)

    This means women can now receive a reliable diagnosis without undergoing surgery or hospital referral — enabling earlier access to care and treatment.

    🧬 The Science Behind the Ziwig Endotest®

    The test works by detecting over 100 specific microRNA molecules present in saliva — tiny regulators that influence how genes behave in the body. These biomarkers are extracted through Next Generation Sequencing (NGS) and interpreted with advanced artificial intelligence (AI).

    This cutting-edge combination of molecular biology and AI allows the Endotest® to identify even early or subtle signs of endometriosis — even when imaging and blood tests are normal.

    Ziwig is also exploring this technology to diagnose ovarian cancer, fibroids, and other gynaecological conditions.

    👩‍⚕️ What to Expect: Patient Guide to the Ziwig Endotest®

    Step 1: Saliva Collection
    A simple, in-clinic collection of a small saliva sample at your GP consultation.

    Step 2: Laboratory Analysis
    The sample is sent for processing, where RNA biomarkers are analysed using NGS and AI algorithms.

    Step 3: Results
    You’ll receive a report within 3–4 weeks, showing whether the biomarkers linked to endometriosis are present.

    Step 4: Next Steps
    Our GPs will review the results with you and develop a personalised care or referral plan as needed.

    ✅ Who Is the Ziwig Endotest® Suitable For?

    Age range: Women aged 18 to 43 years
    Symptoms:

    • Chronic pelvic pain
    • Painful or heavy periods
    • Pain during sex, urination, or bowel movements
    • Rectal bleeding or shoulder-tip pain during menstruation
    • Difficulty conceiving

    The test can be done at any time during the menstrual cycle, including while taking hormonal treatment.

    ❌ Who Should Not Take the Test?

    • Under 18 or over 43 years of age
    • Current infections (including oral or systemic)
    • History of HIV or cancer

    📊 Comparing Traditional vs. Ziwig Endotest®

    Diagnostic MethodTypeInvasivenessPreparation / RecoveryLimitations
    UltrasoundImagingNon-invasiveMinimal preparationMay miss subtle or deep endometriosis
    MRIImagingNon-invasiveMinimal preparationMay not detect small or early lesions
    LaparoscopySurgical procedureInvasiveRequires anaesthetic and recoveryGold standard, but involves surgical risks
    Ziwig Endotest®Saliva-based testNon-invasiveNo downtime; minimal preparationNew technology; not yet standard NHS practice

    ⏳ How the Ziwig Endotest® Helps Reduce Diagnostic Delays

    The current delay in endometriosis diagnosis causes avoidable distress, prolonged symptoms, and fertility complications.

    By offering an accurate, in-clinic diagnostic test, we can:

    • Shorten time to diagnosis
    • Reduce reliance on surgical procedures
    • Improve early access to treatment
    • Support fertility planning

    ❓ Frequently Asked Questions

    Is the Ziwig Endotest® accurate?
    Yes — it detects 97% of confirmed endometriosis cases and is supported by peer-reviewed research.

    Is it covered by insurance?
    Coverage varies by provider and policy. Please check with your insurer directly.

    Is it painful?
    No — the test is completely non-invasive and pain-free.

    How much does it cost?
    The laboratory test costs £1020, plus a GP consultation (£160) at Coyne Medical.

    How do I access the test?
    Book an appointment with one of our experienced GPs to confirm suitability and begin testing.

    📅 Book Your Ziwig Endotest® Consultation

    If you’re experiencing symptoms such as chronic pelvic pain, painful periods, or difficulty conceiving, early diagnosis is essential.

    Our expert team at Coyne Medical offers personalised support and fast access to the Ziwig Endotest®.
    Book now to explore if this test is right for you.

    👉 Book a GP Consultation Online or call us to schedule your appointment.

    DR LUCY HOOPER
    MB BS BSc MRCGP MA DRCOG DCH

    Lucy is a GP and co-founder of Coyne Medical. She graduated with honours from Imperial College London, trained at St Mary’s Hospital, and holds a Master’s in Medical Ethics and Law. Her clinical interests span women’s health, preventive medicine, and genomics, with a particular focus on using advanced biomarkers to build a more complete picture of long-term health.

    British Society for Genetic Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in BBC, The Guardian, Women’s Health, The Times and Tatler

    Book a GP Consultation

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Women’s Health Guides
  • Menstrual Cycle and Cardiovascular Health: A New Perspective for Women

    Menstrual Cycle and Cardiovascular Health: A New Perspective for Women

    Cardiovascular disease (CVD) remains the leading cause of death and disease for women worldwide. In Western countries, approximately 45% of women aged over 20 years are affected by CVD, and it accounts for one-third of all female deaths. Recognising the unique sex-specific aspects in preventing CVD is crucial as historically, studies in cardiovascular disease have frequently focused on men. Recently, there has been growing interest in studying menstrual cycle characteristics and their potential impact on cardiovascular health. 

    Regular menstrual cycles are a vital sign of women’s overall health, signalling normal functioning of the hypothalamic-pituitary-ovarian axis. However, about 20% of women of reproductive age experience irregular and long menstrual cycles due to endocrine disorders that disrupt this axis. These menstrual irregularities have been linked to several health conditions, including insulin resistance, metabolic disturbances, hyperandrogenism, and chronic inflammation. Consequently, they have been associated with an increased risk of coronary heart disease and related mortality, obesity, and type 2 diabetes.

    To gain further insights into the connection between menstrual cycles and CVD, researchers conducted a large population-based cohort study using data from the UK Biobank. This study included over 58,000 women aged 40 to 69 years who had no pre-existing cardiovascular disease at the study’s outset. Participants were asked to report their current menstrual cycle length and regularity. The researchers followed these women for a median duration of 11.8 years, tracking the development of incident CVD cases through national health records and follow-up visits.

    The study revealed some compelling associations between menstrual cycle characteristics and cardiovascular health. Here are the key findings:

    • Women with irregular menstrual cycles were found to have a 19% higher risk of CVD events, including heart disease and atrial fibrillation, compared to those with regular menstrual cycles.
    • Short (≤21 days) menstrual cycles were associated with a 29% higher risk of CVD events, while long (≥35 days) menstrual cycles showed an 11% increased risk. Specifically, short cycles were linked to a greater risk of coronary heart disease and myocardial infarction.
    • Both short and long menstrual cycles were associated with a higher risk of atrial fibrillation.
    • Interestingly, there was a significant interaction between irregular menstrual cycles and lower high-density lipoprotein cholesterol levels and smoking status, suggesting that these factors might influence CVD risk.

    This study adds to the growing body of evidence suggesting that menstrual cycle characteristics throughout a woman’s reproductive lifespan could be associated with cardiovascular disease. Although the findings are significant, more research is needed to fully understand the underlying mechanisms and establish causality. Future studies are crucial to fill the remaining knowledge gaps and determine on how menstrual cycles might be prospectively linked to cardiovascular disease and subsequent events.

    As we strive to ensure that women’s heart health is finally given the prominent status it deserves, understanding the potential impact of menstrual cycle characteristics on cardiovascular health becomes increasingly vital. The findings from the UK Biobank study provide valuable insights into the associations between irregular, short, and long menstrual cycles and CVD risk in women. Armed with this knowledge, women can take proactive steps towards better cardiovascular health. Regular check-ups, maintaining a healthy lifestyle, and discussing any menstrual irregularities with healthcare professionals can go a long way in safeguarding against CVD. 

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Women’s Health Guides
  • Are AMH blood tests useful?

    Are AMH blood tests useful?

    Can the AMH blood test tell me if I’m fertile?

    From bus stops to instagram ads for fertility testing appear everywhere. It can feel like a constant wave of information and worry from fertility all the way to menopause. Lots of companies are now offering testing online or at home with promises of giving you information on your fertility. We know it is a worry for many, busy lives often mean women are  having their first babies later than ever. 

    The focus of many ‘fertility’ tests is a hormone called AMH (Anti-Müllerian hormone) in the blood. It is produced by the ovaries. As a woman gets older the levels will naturally decrease. This fit with what we know about ovaries and eggs. Woman are born with all the eggs they will every have. A newborn has over 1 million eggs, by the time of a girl’s first menstrual period that number may be down to 400,000. The number of eggs continues to decline by the average age of natural menopause, around 51 years of age, only about 1000 eggs are likely to remain. As the number of eggs decreases the amount of AMH produces also decreases. 

    So AMH does give an indicator of egg count. It has been used in fertility clinics for many years as it can help the doctor predict response to the medicines used to stimulate egg production in IVF (in-vitro fertilisation). We have excellent data showing that it is a useful test in women who have had fertility problems and are undergoing fertility treatment. 

    It was hoped that it could also be used for other women to predict fertility. A lot of women would like some insight into their fertility. For instance, a common question in the clinic is can I safely delay pregnancy for a few years? 

    Unfortunately, AMH testing can’t help us make that decision. There was a really important study published on this last year, it followed women between the ages of 30 – 44 years. They were screened with an AMH test and then followed for 3 years. There was no difference in fertility between the groups with a low or normal AMH test. This included measuring chance of giving birth to a live baby, and chance of needing fertility treatment. 

    Like most things in medicine there is likely some grey area. It could be that for some women with risk factors for infertility that an AMH level can give some useful information. But that would be just one piece of looking at their fertility and health. 

    Given the low predictive value of AMH testing, I think it is sensible to be cautious before using these tests to make decisions about fertility or life. Choices such as egg freezing or delaying pregnancy can have a big impact on life, finances and relationships. So make sure you are making them with the best science and information. Just like ‘Magic 8 balls’, AMH tests are not recommended to be relied on to predict fertility in healthy women without a history of infertility. 

    DR LUCY HOOPER
    MB BS BSc MRCGP MA DRCOG DCH

    Lucy is a GP and co-founder of Coyne Medical. She graduated with honours from Imperial College London, trained at St Mary’s Hospital, and holds a Master’s in Medical Ethics and Law. Her clinical interests span women’s health, preventive medicine, and genomics, with a particular focus on using advanced biomarkers to build a more complete picture of long-term health.

    British Society for Genetic Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in BBC, The Guardian, Women’s Health, The Times and Tatler

    Book a GP Consultation

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Women’s Health Guides
  • Do you have dense breasts?

    Do you have dense breasts?

    1 in 7 women in the Uk will have breast cancer in their lifetime.

     Those rates are every decade. Knowing your breast density gives you more power to reduce your risk and catch cancers earlier. 

    The more ‘dense’ your breasts are the more likely you are to get breast cancer. About twice as likely as the ‘average’ woman. But it doesn’t end there, increased breast density also makes it much harder to find cancer on a mammogram (x-ray pictures of the breast tissue). 

    Breasts are a mixture of fat cells, glands and fibrous tissue. Fat shows up black on a mammogram (x-ray pictures of the breast tissue). Women with ‘extremely dense’ breasts have very little fat tissue in the breasts, their mammogram pictures look very white. Breast cancer also appears white on mammograms. So looking for cancers in dense breasts has been likened to looking for a white cotton ball in a snowstorm. It is very hard, the detection rate of mammograms can drop to as low as 24%.

    We offer women over 40 years of age a breast density assessment with their annual mammogram screening. Mammograms are the only way to know your breast density. It is not the same as having large breasts or “lumpy” breasts. 

    We offer mammogram screening including breast density assessment to all women over 40. Breast density is categorised from A to D, groups C ‘heterogeneously dense’ and D ‘extremely dense’ are dense breasts. Offering women in groups C and D follow-up MRI or ultrasound scans can detect cancers missed by their mammogram. 

    We know detecting breast cancer early makes them easier to treat and improves long-term survival. 98% will survive over 5 years after a stage 1 breast cancer diagnosis versus only 1 in 4 (26%) diagnosed at stage 4. MRI scanning for women with ‘extremely dense’ breasts has been shown to reduce their risk of dying from breast cancer. 

    Breast density is so important, so if you have a friend or family member so talking about it and raising awareness is vital. In the USA two doctors, JoAnn Pushkin and Wendi Berg both had breast cancer missed on a mammogram, this has driven their campaign to increase awareness and change policy. Now over 40 US states are required by law to inform women of their breast density after their mammogram. In Europe, Cheryl Cruwys also had breast cancer that her mammogram didn’t pick up and is leading the charge to inform women. If you want to read more check their website here.

    DR LUCY HOOPER
    MB BS BSc MRCGP MA DRCOG DCH

    Lucy is a GP and co-founder of Coyne Medical. She graduated with honours from Imperial College London, trained at St Mary’s Hospital, and holds a Master’s in Medical Ethics and Law. Her clinical interests span women’s health, preventive medicine, and genomics, with a particular focus on using advanced biomarkers to build a more complete picture of long-term health.

    British Society for Genetic Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in BBC, The Guardian, Women’s Health, The Times and Tatler

    Book a GP Consultation

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Women’s Health Guides
  • Exercise in Pregnancy Can Increase the Chances of Vaginal Birth

    Exercise in Pregnancy Can Increase the Chances of Vaginal Birth

    A frequent question that we are asked by pregnant mum’s attending the clinic is whether they can continue to exercise during pregnancy. Many of the mums-to-be are worried that exercise may harm the baby or increase the risk of preterm birth. 

    Doctors previously assumed that pregnancy would increase the risk of preterm birth by reducing the blood flow to the placenta which provides vital nutrients to the baby. A recent study set out to check whether exercise in pregnancy really did increase the risk of preterm birth. They carried out a meta-analysis, a study that collects together all the results of previous good quality studies and pools them together. The study only included women who had an uncomplicated, single (i.e. not twin) pregnancy. In total 2059 women were included in the study and, interestingly, all of them were sedentary prior to the studies starting. A wide variety of exercises were tested in the studies including personal training, static cycling, resistance training, swimming, mobilization, and core workouts. 

    The results showed that women who exercised throughout pregnancy doing 35 minutes of exercise 3-4 times per week had no difference in the rate of preterm delivery than those who did no exercise. There was also no difference in birth weight of babies born to mothers who did exercise compared to those who did not. 

    However, women who exercised regularly were more likely to have a vaginal birth and less likely to have a Caesarean Section. In addition, exercise reduces the likelihood of women developing Diabetes in pregnancy or experiencing problems with high blood pressure. 

    So exercise in an uncomplicated pregnancy is not only safe but can also improve chances of vaginal birth and reduce the risk of diabetes and high blood pressure. If you would like to know more about what exercise would suit you in your pregnancy, then contact our team.

    DR LUCY HOOPER
    MB BS BSc MRCGP MA DRCOG DCH

    Lucy is a GP and co-founder of Coyne Medical. She graduated with honours from Imperial College London, trained at St Mary’s Hospital, and holds a Master’s in Medical Ethics and Law. Her clinical interests span women’s health, preventive medicine, and genomics, with a particular focus on using advanced biomarkers to build a more complete picture of long-term health.

    British Society for Genetic Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in BBC, The Guardian, Women’s Health, The Times and Tatler

    Book a GP Consultation

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Women’s Health Guides
  • Breast Ultrasound

    Breast Ultrasound

    When we think about imaging for breasts, typically mammograms come to mind. Yet, ultrasound also has an important role to play and is commonly used. Ultrasound is usually the first-line imaging investigation for women under 40 with symptoms like new breast changes or a lump. In women aged 40 and above, ultrasound is often used in combination with mammography. Think of the two as complementary tests which have different strengths. Some things are better seen on mammography, whilst others are better seen on ultrasound. Ultrasound is particularly good at differentiating between lumps that are solid and cysts containing fluid. Ultrasound is also frequently used to accurately guide procedures in real-time. This includes removing fluid from painful cysts and taking tissue samples from breast lumps.

    Breast density, screening and imaging

    Mammography tends not to be used in younger women because they tend to have “denser” breasts. This means they have a higher proportion of normal fibroglandular tissue. This makes the mammograms look “whiter” and can hide breast pathology which also appears white. It’s a bit like trying to detect a white sticker on the background of a white wall. Your doctor may suggest additional imaging like ultrasound if mammography shows dense breasts. The use of ultrasound for dense breasts and for screening, used in some countries, is a subject of debate. It is important to be aware of the pros and cons to make an informed decision. On one hand, using ultrasound in addition to mammography can increase the chances of picking up a cancer. On the other hand, using ultrasound also increases the likelihood of picking up other benign lesions which may never have caused harm if they were not detected, but once found may need further imaging or a biopsy to confirm a benign diagnosis. So it is worth discussing with your doctor the nuances of this.

    How does it work and what happens during the ultrasound appointment?

    The same technology used to look at babies during pregnancy is used to evaluate the breasts. Unlike other imaging tests which use ionising radiation to generate images, ultrasound uses sound waves that are safe and bounce off the areas of interest to generate images. You will be asked to undress from the waist up and lie down on a couch. The doctor will put gel on a transducer to help the sound waves travel and the transducer will be placed on the skin. An image will be generated on the monitor in real-time and different images will appear as the doctor moves the transducer. The doctor will then review their images and produce a report on their findings.

    DR NEIL UPADHYAY
    MBBS BSc FRCR MRes MEd

    Neil is a Consultant Radiologist at Imperial College Healthcare NHS Trust, subspecialising in breast and musculoskeletal radiology. He completed his medical degree and BSc in Management with Medical Sciences with first class honours at Imperial College London, was appointed as a Consultant Radiologist in 2014, and holds two Master’s degrees from Imperial College London, both completed with distinction.

    Book a Breast Ultrasound

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cancer Health Guides
  • Preventing ACL injuries in Women and Girls

    Preventing ACL injuries in Women and Girls

    ACL injuries are common and can lead to a long time away from playing sport. Recovery can often take 9 months. Having had an ACL injury also increases the risk of having further knee problems down the line. 

    The ACL, or anterior cruciate ligament, is at the front of a pair of ligaments that form a cross. Its role is to prevent the thigh bone (Femur) from sliding too far forward over the shin bone (tibia).

    Why Women and Girls are More Likely to Suffer ACL Injuries

    Women are about 4 times more likely to rupture their ACL than men are. Most ACL tears in women are non-contact injuries that usually occur during an awkward twisting motion. Certain sports have a higher risk of ACL tear. Typically, sports that have rapid stopping or changes in direction, landing from a jump or cutting motions are the highest risk. This includes netball, basketball, football and volleyball. 

    There are several reasons that women and girls are more prone to suffering from ACL injury. Many of these factors, such as female hormones, wider hips and more lax knees cannot be altered. Thus, focusing on preventing ACL injuries has to focus on what we can change.

    Landing Differences

    Two big factors can be changed to help reduce the likelihood of ACL injuries in women and girls. The first is how females tend to land from a jump. Two landing patterns that are particularly risky are landing with stiff, straight legs or landing in a knock-kneed position. These risky landing techniques are more common in women than in men and greatly increase the force through the knees as well as the risk of ACL injury. 

    Hamstrung by Hamstrings

    The second factor that can be altered to reduce ACL injury is what is known as neuromuscular adaptation. This refers to the strength, explosivity, timing and coordination of muscular contraction. Having sufficient strength, as well as being able to engage the right muscle at the right time during movement is crucial for knee stability. The hamstrings are particularly important in knee stability, as like the ACL, they stop the shin bone from sliding too far forward. Females take longer than males to produce force in their hamstrings and contract them more slowly. 

    How To Land Well To Prevent ACL Injuries in Women and Girls

    To land well and reduce the risk of injury observe yourself jumping from a plyometric box or workout step in front of a mirror. Or, ideally, you could also have a partner observe you or film it on your phone. Start and finish the jump with the knees and hips bent. Make sure you keep your knees over and in line with your second toes as you land and that the knees don’t collapse inwards.  Try to land as softly as possible on the front half of the soles of your feet. 

    Strengthening To Prevent ACL Injuries in Women and Girls

    Strengthening hamstrings is really important for ACL prevention. A great exercise for this is Steamboats. Having strong glutes (bum muscles) is also important. They help stop the knees from knocking together. Lateral steps using a theraband and single-leg bridges can be great for this. Stabilising the trunk through core stability exercises such as plank can also help reduce the risk of leg injuries. 

    Plyometric drills such as tuck jumps and squat jumps can help with muscle explosivity and timing or muscle contraction. The core component of these exercises is the squat. it is a foundational move for athletic endeavours. Agility drills such as fast feet can also help improve power and speed while reducing injury risk. 

    If you master these tips, you’ll greatly reduce your risk of ACL injury.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Nutrition & Lifestyle Guides
  • The pill, patch or ring? What are my contraceptive options?

    The pill, patch or ring? What are my contraceptive options?

    What are my contraceptive options?

    Most people are familiar with the contraceptive pill or ‘the pill’ as it is better known however there are many other forms of contraception available and more and more people are now availing of these options. There are five types of contraception: hormonal, barrier, intrauterine (inserted inside the uterus/womb), sterilisation and natural. The choice is very much patient driven and the decision should be made after appropriate counselling with an adequately trained healthcare professional.

    The following methods require consistent use to work effectively (user dependent);

    Happy to think more often about your contraception?

    Combined oral contraceptive pills (COCs): These contains 2 different types of hormones (oestrogen & progesterone) and the typical dose is one tablet daily for 21 days and then a ‘pill free week’ where you have a withdrawal bleed/period. There are different choices of oestrogen and progesterone and there are also different strengths of each. The decision of which option to go for depends of a person’s cycle, period flow (heavy/light), age, if there are skin complaints (e.g. acne), mood issues (low mood or PMT (pre-menstrual tension), bleeding issues with other pill options and many other factors.

    Mode of action

    • The synthetic oestrogen stops your body from producing two hormones that are involved in the menstrual cycle: Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH). This prevents your ovaries from producing an egg because it stops your eggs from ripening and ovulating.
    • The synthetic progesterone thickens the mucus at the entrance of your womb so that sperm can’t get through to fertilise your eggs and also thins the lining of the uterus, making it difficult for a fertilised egg to implant itself.

    Advantages

    • Typical effectiveness* (i.e. prevent pregnancy), perfect effectiveness* 99%.
    • Useful for women who do not want a long term contraceptive method and  are able to comply with the daily medicine schedule.
    • Often reduced bleeding and period pain, and may help with premenstrual symptoms.

    Drawbacks

    • Oestrogen component may not be suitable for some women depending on medical history.
    • May not be suitable for women who could forget to take the pill.
    • Effectiveness can be affected by vomiting or diarrhoea (if severe/persistent) or other medication you are taking.

    Progesterone only pill/POP/’mini pill’: This contains only progesterone of which there are different types available. This pill is taken every day of the cycle/month and there is ‘-no pill free week’.

    Mode of action

    • The majority of mini pills work by thickening the cervical mucus, making it difficult for sperm to get through to fertilise an egg and thinning the lining of the uterus, making it less likely that a fertilised egg will implant itself.
    • Cerazette (desogestrel), the most commonly used mini pill, also works by preventing ovulation.

    Advantages

    • Typical effectiveness 91%*, perfect use effectiveness 99%*.
    • May be suitable for women who do not want to or who cannot take oestrogen e.g. due to medical history.
    • May be used safely in breastfeeding women

    Disadvantages

    • Woman may have changes in menstrual pattern (periods), can cause irregular bleeding/heavier bleeding.
    • Effectiveness can be altered by vomiting/diarrhoea/other medication taken.
    • May not consistently prevent egg release.

    Combined contraceptive patch (CCP): Contains both oestrogen & progesterone and mode of action is same as COC pill.

    Advantages

    • Typical effectiveness 91%, perfect use effectiveness 99%*.
    • Patient should apply one patch per week for 3 weeks and then have a patch free week in week 4.
    • Not affected by vomiting or diarrhoea

    Drawbacks

    • May be seen on the skin
    • Oestrogen component may not be suitable for some women depending on medical history.

    Vaginal ring: Flexible ring which is placed inside the vagina and contains both oestrogen and progesterone. Similar mode of action as COC and CCP.

    Advantages

    • Typical effectiveness 91%, perfect use effectiveness 99%*.
    • Only needs to be replaced once per month (one week following removal (ring free week)).
    • Not affected by vomiting or diarrhoea

    Drawbacks

    • Need to learn how to insert (via trained individual)
    • Oestrogen component may not be suitable for some women depending on medical history.

    Condoms: Male & female, acts as barrier, does not contain any hormones and use is not restricted due to medical history.

    Advantages

    • Typical effectiveness for male is ~82%; perfect use effectiveness is ~98%*.
    • Typical effectiveness for female is ~79%; perfect use effectiveness is ~95%.
    • May be useful for those who wish to avoid hormones, or as additional protection.
    • The only contraception that offers protection against sexually transmitted infections.

    Drawbacks

    • Putting them on can involve interruption of sexual intercourse.
    • The male condom can split or rupture.
    • The female condom can be accidentally dislodged.

    Diaphragm & caps: Barrier method that fits inside the vagina, does not contain hormones and use is not restricted to your medical history.

    Advantages

    • Typical effectiveness 71-88%*; perfect use effectiveness (when used with       spermicide) ~92-96%*.
    • For women who do not want a long term contraception method but who wish to avoid taking hormones.

    Drawbacks

    • Can take time to learn how to use
    • Involves forward planning or interruption of intercourse.
    • Can be messy as you need to use spermicide as well.

    Natural methods: Recognising the fertile and infertile times of your cycle to plan when you should avoid intercourse.

    Advantages

    • Efficacy will vary depending on the type of NFP method used, if/how many methods used concurrently and how reliably it is adhered to; typical effectiveness ~76%*, perfect effectiveness can be between 91-99%*.
    • May be useful for those who wish to avoid hormones or devices.
    • Can be used at all stages of reproductive life.

    Drawbacks

    • There are different types of NFP methods and it can take up to 6 months to learn effectivity
    • Stress or illness can make the method unreliable.
    • Need to avoid intercourse at certain times of the month and be highly motivated.
    • Does not protect against sexually transmitted infection

    For further information:
    https://patient.info/health/contraception-methods/natural-family-planning-methods

    Don’t want to think about contraception everyday/every time you have sex?

    Then why don’t you consider Long Acing Reversible Contraceptive methods (LARC).

    IUD/intrauterine device: Copper containing coil inserted into the womb and can remain in place for 5-10 years (depending on type used), does not contain hormones so does not interact with other medications.

    Mode of action

    The copper released makes the uterus an in-hospitable environment for sperm.

    Advantages

    • Typical & perfect use effectiveness is over 99%*->user independent.
    • For women who want longer-term contraception but do not want hormones.
    • Fertility should return to levels expected for you after removal.
    • May be used safely in breastfeeding women

    Drawbacks

    • Women may have changes in menstrual patterns (periods).
    • Insertion and removal must be performed by trained healthcare professional

    IUS/intrauterine system/better known as Mirena coil: Progesterone containing coil/device fitted into womb and can last 3 or 5 years depending on type used.

    Mode of action

    • Progesterone is released daily and essentially works by preventing fertilization.

    Advantages

    • Typical & perfect use effectiveness is over 99%*-> user independent.
    • Fertility should return to levels expected for you after removal.
    • Can greatly help with patients with heavy periods.
    • May be used safely in breastfeeding women

    Drawbacks

    • Some women may have issues with bleeding.
    • Insertion and removal must be performed by trained healthcare professionals.

    Contraceptive implant: Progesterone containing implant inserted under the skin of the upper arm which lasts for up to 3 years.

    Advantages

    • Typical & perfect use effectiveness is over 99%*-> user independent.
    • Fertility should return to levels expected for you after removal.
    • May be used safely in breastfeeding women

    Drawbacks

    • Women may have changes in menstrual pattern
    • Insertion and removal must be performed by trained healthcare professionals.

    Contraceptive injection: Progesterone containing injection given every 8-13 weeks, depending on the type used.

    Advantages

    • Typical effectiveness ~94%, perfect use effectiveness ~99%*.
    • Short-term LARC for women and couples awaiting sterilisation or vasectomy.
    • May be used safely in breastfeeding women

    Drawbacks

    • Women may have changes in menstrual patterns
    • Can take time for fertility to return to normal.
    • Can affect bone density

    Want long-term contraception?

    Sterilisation (male & female): Fallopian tubes that carry the egg in women or the vas deferens that carry sperm in the male are cut or clipped.

    Advantages

    • Failure rate is ~1 in 200 or 1 in 500 for females (depending on method) and   1 in 20,000 in males.
    • May be suitable for those who want a permanent method of contraception that involves no hormones.

    Disadvantages

    • Cannot be easily reversed.
    • Involves an operation/procedure.
    • Sterilisation is not effective immediately.

    *’These are ‘typical’ effectiveness rates which is how effective the method is with an average person. Typical rates tend to reflect real life usage (including inconsistent and incorrect use). ‘Perfect’ effectiveness rates is how effective the method is when used perfectly. Refer to the patient information leaflet for ‘perfect use’.

    In conclusion, there is a large variety of contraceptive options available, so please enquire when you are next in with your local GP to see what would best suit you.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

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    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

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