Tag: Women’s Health

  • Can you prevent breast cancer? Risk, screening and genetic testing explained

    Can you prevent breast cancer? Risk, screening and genetic testing explained

    Breast cancer affects 1 in 7 women over their lifetime. But risk is not uniform, and early detection changes outcomes dramatically. This guide covers what raises your risk, what the latest screening tools can offer, and when genetic testing should be part of the picture

    1. What causes breast cancer?
    2. Family history and genetic risk
    3. Lifestyle risk factors
    4. Breast density
    5. Symptoms to know about
    6. Screening options
    7. Genetic testing for inherited risk
    8. Support and further information

    What causes breast cancer?

    No single thing causes breast cancer. For most women, it comes down to a mix of genetics, hormones, lifestyle, and chance. The good news is that many risk factors can be identified, and some can be changed.

    Breast cancer is the most common cancer in UK women. Around 150 new cases are diagnosed every day. 1 in 7 women will be diagnosed with breast cancer during their lifetime. Survival has improved a lot in recent years, mainly because of better treatments and earlier diagnosis. Stage 1 breast cancer now has a five-year survival rate above 98%. That figure drops significantly when cancer is found later, which is why screening matters so much.

    Family history and genetic risk

    Family history

    If your mother, sister, or daughter has had breast cancer, your own risk is roughly double the average. The risk is higher if they were diagnosed under 50, or if several relatives on the same side of the family have been affected. It is also worth knowing that breast cancer genes can be passed down through male relatives, who may carry a mutation without ever developing the disease themselves.

    Inherited gene mutations

    About 5% to 10% of breast cancers are caused by an inherited fault in a gene. The most well known are BRCA1 and BRCA2. Women with a BRCA1 mutation can have a lifetime breast cancer risk of up to 90%. Other genes, including PALB2, CHEK2, and ATM, also raise risk, though usually by a smaller amount. These gene faults do not cause cancer directly. What they do is make it harder for the body to repair DNA damage over time, which means errors in cells are more likely to build up into cancer.

    Hormonal factors

    Starting periods early or reaching menopause late both mean more years of oestrogen exposure, which is linked to a modest increase in breast cancer risk.

    The relationship between HRT and breast cancer has caused a lot of confusion, but the evidence is now much clearer. Combined HRT, which includes both oestrogen and a synthetic progesterone, does carry a small real increase in risk. The estimate is around ten extra cases per 1,000 women taking it for up to 14 years from age 50. Body-identical progesterone (sometimes called Utrogestan or micronised progesterone) appears to carry much less risk, and current evidence suggests the increase may be close to zero in the first five years of use. Women who take oestrogen alone, because they have had a hysterectomy, are not thought to have any meaningful added breast cancer risk from HRT. If you are weighing up HRT and are worried about breast cancer, your GP should look at your full risk picture rather than giving a blanket answer.

    Lifestyle risk factors

    Alcohol

    Even moderate drinking raises breast cancer risk. Around two units a day, roughly a single glass of wine, is linked to about a 9% increase in risk. That is a bigger rise than most people expect, and larger than the risk from combined HRT.

    Weight and body fat

    Being overweight after the menopause increases risk. Fat tissue produces oestrogen, and higher oestrogen levels after the menopause are linked to breast cancer. Weight carried around the middle is particularly important. Visceral fat, the fat stored around your internal organs, is more hormonally active than fat under the skin, and more directly linked to cancer risk. This is why knowing your body composition, not just your weight, matters.

    Exercise

    Regular exercise reduces risk. Brisk walking for 30 minutes, five days a week, can lower breast cancer risk by up to 12%.

    Smoking

    Current smokers have around a 10% higher risk compared to people who have never smoked.

    Having children and breastfeeding

    Women who have had children have a lower overall risk than those who have not. Breastfeeding adds further protection, probably because it delays the return of periods.

    Previous radiotherapy

    If you have had radiotherapy to your chest, for example for lymphoma, this raises your breast cancer risk. Let your GP know so they can factor it into your screening plan.

    Breast density

    Breast density is one of the less talked about risk factors, even though it affects up to half of women over 40.

    Dense breast tissue means your breasts contain more fibrous and glandular tissue relative to fat. This matters for two reasons. First, women with the highest density category have roughly double the breast cancer risk of women with mostly fatty breast tissue. Second, dense tissue and potential cancers both appear white on a mammogram, which means dense breasts can hide problems that mammography might otherwise catch.

    Breast density can only be seen on a mammogram. It has nothing to do with how your breasts feel. We have written a dedicated guide that covers what dense breasts mean for your screening choices and what options are available at Coyne Medical.

    Understanding dense breasts →

    Symptoms to know about

    Most breast cancers are found through screening before any symptoms appear. But it is still important to know what to look out for. See a GP promptly if you notice any of the following. None of these automatically means cancer, but all of them should be checked.

    A lump or swelling in the breast, upper chest, or armpit. A change to the skin, such as puckering or dimpling. Redness or a change in colour of the breast. A nipple that has become newly inverted or changed shape. A rash or crusting around the nipple. Unusual discharge from either nipple. A change in the size or shape of the breast that you cannot explain.

    Screening options

    NHS mammography

    The NHS invites women aged 50 to 71 for a mammogram every three years. Mammography uses low-dose X-rays and can detect cancers before they are large enough to feel. If you think you may have missed an invitation, you can find your nearest NHS breast screening centre online and self-refer. Women identified as higher risk through family history may be offered NHS screening from age 40 instead.

    Why starting earlier makes sense

    The UK starts breast screening later than most comparable countries. There is strong evidence that annual mammography from age 40 can reduce the risk of dying from breast cancer by around 25% over ten years. At Coyne Medical, annual mammography from 40 is included as standard in our Complete and Ultimate health screening packages. Mammograms are mildly uncomfortable but only take a few minutes. Modern machines use a very low radiation dose, similar to about seven weeks of natural background radiation.

    Breast ultrasound

    Ultrasound uses sound waves rather than radiation and is particularly useful for women with dense breasts. It can find cancers that mammography misses, and it can tell the difference between solid lumps and fluid-filled cysts. At Coyne Medical, breast ultrasounds are carried out by Dr Neil Upadhyay, a Consultant Radiologist at Imperial College Healthcare NHS Trust with specialist expertise in breast imaging.

    Book a breast ultrasound →

    Breast MRI

    MRI is the most sensitive test available for breast cancer detection. It is recommended for women at high risk, such as those with a confirmed BRCA1 or BRCA2 mutation, or women who have had radiotherapy to the chest. The European Society of Breast Imaging also recommends MRI for women with dense breasts who have additional risk factors, such as a significant family history. It is not used for general population screening because of cost and a higher rate of false alarms, but for the right patient it offers much greater sensitivity than mammography alone. If you have dense breasts and other risk factors, speak to your GP about whether MRI is appropriate for you.

    Multi-Cancer Early Detection: TruCheck

    TruCheck is a blood test that looks for tumour cells that have broken off from a cancer and entered the bloodstream, before any symptoms have appeared. It screens for over 70 types of cancer from a single blood draw.

    The evidence for breast cancer detection is particularly strong. In a 2022 study by Crook et al., published in the journal Cancers, the test correctly identified breast cancer with a sensitivity of over 92% across a population of more than 9,000 participants. A follow-up clinical study found similar results.

    TruCheck Multicancer Early Detection Blood test is generally suitable for people aged 40 and over who have not previously been diagnosed with cancer. People aged 35 to 39 with a strong family history or a known gene mutation can also be considered. It is not a replacement for imaging but adds an extra layer of detection.

    Multi-Cancer Early Detection →

    Genetic testing for inherited risk

    Genetic testing used to be offered only to people with a clear family history of cancer. But research now shows this approach misses nearly half of people who carry a high-risk mutation. Mutations can run through male relatives who never develop breast cancer. Relatives may have died young before any cancer appeared. Families may simply be small, with no obvious pattern to notice.

    At Coyne Medical, we offer genetic testing to everyone, not just those who meet a high-risk threshold. We know fewer than 5% of people in the UK with a high-risk mutation have been identified. We want to help you find any inherited risk early.

    Who should particularly consider it

    A personal or family history of breast or ovarian cancer, especially under age 50. Several affected relatives on the same side of the family. Male relatives with breast, prostate, or pancreatic cancer. Ashkenazi Jewish heritage, which carries a higher rate of BRCA1 and BRCA2 mutations in the population. A known mutation in the family. If any of these factors apply to you, it is worth finding out.

    What a positive result means

    A positive result does not mean you will get cancer. What it does is change what screening makes sense for you, and opens the door to options that could significantly reduce your risk. Women with a BRCA1 mutation, for example, are offered annual mammography and MRI by the NHS from age 30, and may be candidates for medication or surgery that can cut breast cancer risk by over 95%.

    What a negative result means

    No harmful mutations were found in the tested genes. This is genuinely reassuring. It does not eliminate all breast cancer risk, particularly if you have a strong family history, but it is meaningful information. You should still continue appropriate screening based on your other risk factors.

    What about male relatives?

    Half of people who carry a BRCA1 or BRCA2 mutation are male. Men with these mutations have a raised risk of prostate cancer, male breast cancer, and pancreatic cancer. A man with a BRCA2 mutation has up to a 60% lifetime risk of prostate cancer, more than eight times the population average. Male relatives in families affected by breast or ovarian cancer should consider testing too.

    At Coyne Medical we offer an inherited cancer risk panel covering 35 genes, available as an at-home saliva test from £650 or an in-clinic blood test from £900. Our Advanced Genetic Screen covers 55 genes and also includes a pharmacogenomics report. Genetic testing is included as standard in our Ultimate health screening package.

    Inherited cancer risk panel →

    Advanced genetic screen →

    Support and further information

    If you have concerns about your breast cancer risk or about inherited breast cancer in your family, the following organisations can help. The National Hereditary Breast Cancer Helpline offers support for people at risk of hereditary breast cancer. Breast Cancer Now is a leading UK charity with information and a clinical nurse helpline. Jnetics focuses specifically on prevention and diagnosis in the Jewish community. Peer support groups for people with BRCA and other gene mutations are also available online and can be a valuable source of connection alongside clinical advice.

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  • Understanding dense breasts

    Understanding dense breasts

    If you’ve been told you have dense breasts after a mammogram, you may have questions about what it means and whether you need to do anything differently. This guide explains what breast density is, why it matters for cancer detection, and what your options are.

    What are dense breasts?

    Breast tissue is made up of a mixture of fat, fibrous tissue, and glandular tissue. Breast density refers to the proportion of fibrous and glandular tissue relative to fat, as seen on a mammogram. The more fibrous and glandular tissue you have, the denser your breasts are considered to be. On a mammogram test your breast tissue will appear more white.

    Density is graded on a four-point scale, from A (almost entirely fatty) through to D (extremely dense). Categories C and D are generally referred to as dense. Up to half of women over 40 years of age have dense breast tissue, so if you have been told your breasts are dense, you are far from alone. Density is a normal biological characteristic, not a disease or abnormality in itself.

    Why breast density matters

    There are two distinct reasons why breast density is clinically relevant, and it is worth understanding both.

    The first is cancer risk. Dense breast tissue is independently associated with a higher risk of developing breast cancer. Women with category D density have roughly double the risk of breast cancer compared to women with category B tissue. The reasons are not fully understood, but this association is well established in the research literature and informs screening guidance worldwide.

    The second is mammogram sensitivity. Dense tissue and potential cancers both appear white on a mammogram, which means that dense tissue can obscure abnormalities that might otherwise be detectable. Studies suggest that between 30% and 50% of cancers may not be visible on mammogram in women with dense breasts. This is sometimes called the masking effect.

    These two factors together mean that if you have dense breasts, your standard mammogram may be both less reassuring and less complete than it would be for someone with fatty tissue.

    What the guidance says

    The European Society of Breast Imaging published updated guidance in 2022 recommending that women with dense breasts be informed about the limitations of mammography and offered additional imaging, either ultrasound or MRI, depending on their overall risk profile. In the United States, mammogram facilities are now legally required to report breast density to patients so they can make informed decisions about supplemental screening. Extra screening is also routine in other European countries including France.

    UK guidance has been slower to formalise this, but the clinical case for supplemental imaging in women with dense breasts is well supported by the evidence, and an increasing number of women are seeking private assessment outside the NHS screening programme as a result.

    Your options for supplemental screening

    For most women with dense breasts who are at average or slightly elevated risk, breast ultrasound is the recommended first step beyond mammography. It uses sound waves rather than radiation, is non-invasive, and is particularly good at distinguishing between solid masses and fluid-filled cysts in dense tissue. It can detect cancers that are not visible on mammogram.

    For women at higher than average risk, for example, those with a strong family history of breast cancer, a breast MRI is the most sensitive available test. Your GP can help you discuss whether MRI screening is appropriate for your situation.

    If you are unsure which option is right for you, a GP consultation is a good starting point. Understanding your full risk picture, including family history and any relevant genetic factors, will help you and your doctor decide on the most appropriate next step.

    How Coyne Medical can help

    We offer breast ultrasound at our Fulham clinic with Dr Neil Upadhyay, a Consultant Radiologist with specialist expertise in breast imaging. Appointments are available on a private self-pay basis without a GP referral, though we would always recommend discussing your results with a GP who knows your full history.

    If you would like to understand your broader cancer risk before or alongside breast imaging, our genetic cancer testing service covers 35 inherited cancer risk genes including BRCA1 and BRCA2, with results reviewed by a Coyne Medical GP.

    Book a breast ultrasound →

    FAQs

    You may be told in your mammogram report. In England, NHS mammogram letters do not routinely tell you about breast density. At Coyne Medical we always request this extra information in your mammogram report, if you are using a different private provider do ask them about this. If you are unsure what your report says or what it means for you, bring it to a GP consultation and they can help you interpret it in the context of your overall health history.

    Yes. Breast density typically decreases with age and tends to reduce after the menopause, partly because falling oestrogen levels lead to a reduction in glandular tissue. Hormone replacement therapy can maintain or increase density in some women. It is worth being aware that your density category at one screening may not reflect your density at the next.

    Yes. Breast ultrasound uses sound waves and does not involve ionising radiation, making it safe to repeat as often as clinically indicated. It is the same technology used in pregnancy ultrasound scans and has an extensive safety record.

    No. The majority of women with dense breasts do not develop breast cancer. Density is one risk factor among several, and having it does not make cancer inevitable. What it does mean is that your standard mammogram may not give you the full picture, and supplemental imaging is worth considering.

    There is no reliable way to significantly reduce breast density through lifestyle changes, though maintaining a healthy weight and limiting alcohol may have a modest effect for some women. The most important thing is not to try to change your density, but to make sure your screening approach accounts for it.

    Genetic testing is a separate consideration from breast density, though for some women the two are relevant at the same time. If you have dense breasts and a family history of breast or ovarian cancer, or if you are of Ashkenazi Jewish heritage, genetic testing for BRCA1, BRCA2, and other inherited cancer risk genes is definitely worth discussing with your GP. At Coyne Medical, we offer inherited cancer risk panels as a standalone service or as part of our health screening packages. We offer this to all women regardless of family history, as studies show about half those that test positive for a gene like BRCA1 do not have a worrying family history.

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    Not sure which screening is right for you?

    Book a 30-minute Discovery Call with one of our GPs. We will talk through your health history, your concerns and your goals, and recommend the right programme for you.
    The £250 fee is fully credited against any health screening package you go on to book.

    BOOK A DISCOVERY CALL

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  • 10 facts you need to know to prevent ovarian cancer or detect it early

    10 facts you need to know to prevent ovarian cancer or detect it early

    There are so many myths about Ovarian Cancer. For this Ovarian Cancer Awareness month, I’d love to share information to help educate as many women, and doctors on ovarian cancer. We need to use the latest science to make sure we prevent as many cancers as possible and diagnose any ovarian cancer as early as possible. 11 women die every day in the UK of ovarian cancer so every woman should know how to reduce their risk.

    1. Any family history of ovarian cancer matters

    About 20% of ovarian cancers happen because of a change or variant in a gene that has been inherited from a parent. You might also hear these called a “gene mutation” or “faulty gene”. 

    The most common genes involved in this are BRCA1 and BRCA2. If you have inherited a harmful, what we call a “pathological” variant in one of these genes you can have a risk of up to 60% of ovarian cancer in your lifetime. Other genes also increase your risk to lower levels. 

    Angelina Jolie shared her story of finding out about her BRCA1 variant in 2013, she helped to open the conversation around genetic screening. She sadly lost her mother to cancer due to the same BRCA1 variant. She chose to have risk-reducing surgery to reduce her risk of breast and ovarian cancer. She spoke powerfully of how grateful she was to reduce her cancer risk, likely by over 95%. 

    2. We need to offer more people genetic screening

    We estimate over 95% of women who have inherited a harmful variant in BRCA1 or BRCA2 are undiagnosed in the UK. That’s hundreds of thousands of people who don’t know they are at high risk of ovarian cancer, plus others including breast cancer. 

    If you have a family history of ovarian cancer it is sensible to consider genetic screening. Because for these groups screening gives the power of prevention. There are two main options for this. Some women will opt to have their ovaries and fallopian tubes removed. Especially if they have already entered menopause, you could say they are no longer serving any purpose so why keep them and add to your cancer risk? There is a brilliant UK study called “Protector” which offers women who want to keep their ovaries the option of removing their fallopian tubes. We think many cancers start at the end of the tubes close to the ovaries so this option could help reduce risk without the negative impact of menopause in younger women.

    3. Anyone can benefit from genetic screening

    Traditional criteria for screening only those with a family history will miss 50% of people with a pathological variant in BRCA1 or BRCA2. 

    So if you want to get serious about optimising your cancer screening and prevention we think genetic screening is crucial. 

    I know the truth behind these statistics. I tested positive for a pathological variant in a gene called PALB2 in 2020. I did not meet the normal criteria for testing and would not have known without choosing genetic screening. I feel incredibly lucky I found my gene mutation while I was healthy. I have been able to join Angelina Jolie in having preventative risk-reducing surgery. To be able to reduce my risk of cancer by over 95% feels like a very special gift and I would love to see more women share this. 

    4. A family history of other cancer could be linked to ovarian cancer

    The genes that increase the risk of ovarian cancer are linked to other cancers. If your family history includes breast cancer, pancreatic cancer or prostate cancer it is especially important to consider genetic screening. 

    We would also encourage men with a family history of these cancers to consider genetic screening, not just for their own health but because it could impact their daughters, granddaughters, nieces, and sisters..

    5. MYTH: “It doesn’t matter as there is no family history on my Mum’s side.”

    This is such a common myth. You can inherit these gene mutations from either your mother or father. Women who inherit from their Dad are more often not tested, that’s because their Dad is less likely to get breast cancer and can’t get ovarian cancer they are less likely to meet those rubbish “family history” criteria.  A history of cancer in a grandmother or aunt, who may have died before you were even born sounds less concerning than if it is your own mother but it is still a really important risk factor. 

    6. Jewish ancestry is a major RED flag to consider genetic screening

    Having a parent or grandparent with this ancestry is a big risk factor for inheriting a BRCA1 or BRCA2 genetic variant, up to a 1 in 40 chance. The NHS has recently started a project offering testing for gene variants which are more common in that background, if you’re interested you can find out more about the project here. You would also be eligible for our genetic screening which will screen not just BRCA1 and BRCA2 but also a wider range of genes linked to cancers which we can reduce or prevent. 

    7. There are things you can do to look after your health and reduce your risk

    There are lots of factors we can focus on to reduce the risk of ovarian cancer. And they will also reduce your risk of lots of other cancers such as breast and colon cancer. Keeping a healthy weight and not smoking are key. The oral contraceptive pill also reduces risk, as does breastfeeding. There has been a lot of concern about using talcum powder on the genital area and ovarian cancer, the evidence is mixed but it is sensible to avoid this. 

    8. Be symptom aware

    For those cancers we can’t prevent, we need to diagnose these as early as possible. Sadly two-thirds of women are diagnosed at a late stage. If we can diagnose women early at stage 1 the survival rate is over 94% at 5 years, versus only 16% for women diagnosed at stage 4. 

    Symptoms to watch for include:

    • Persistent increase in abdominal size or bloating (not bloating that comes and goes)
    • Persistent pelvic and abdominal pain
    • Unexplained change in bowel habits
    • Difficulty eating and feeling full quickly, or feeling nauseous
    • Needing to urinate (wee) more regularly

    Other symptoms can include tiredness, losing weight, pain during sex, and back pain. These can be symptoms of many other conditions too so don’t panic but see your doctor. They should consider checking a blood test called Ca125 and you may also need an ultrasound scan. 

    9. MYTH: “A smear test checks for ovarian cancer.”

    This is sadly common, about 1 in 4 women think this is true but sadly not. Cervical screening will not detect ovarian cancer.

    10. We can screen for ovarian cancer

    We don’t routinely recommend women use ultrasound or the Ca125 blood test for ovarian cancer screening because the biggest UK trial didn’t show this could improve survival in women, it is possible some women were diagnosed at an earlier stage. The test can also give “false alarms”, other conditions like endometriosis or fibroids can cause high Ca125 levels too. 

    We now have a new blood test that can be used to screen for ovarian cancer. It uses a normal blood sample taken in the clinic and the laboratory to look for ‘circulating tumour cells’, (CTCs). When a cancer or ‘tumour’ starts to grow in the body some of the cells will get into the bloodstream called CTCs. The really exciting part of this is that these CTCs can be found in early-stage 1 cancers.  

    The blood test is called a Multi Cancer Early Detection test, we offer tests by Trucheck that can either focus on female cancers or screen for up to 70 solid organ tumours. 

    Knowledge is power

    Many women and doctors lack knowledge of ovarian cancer. A study by Target Ovarian Cancer showed less than 5% of women were confident in knowing the signs of ovarian cancer. Many doctors also falsely believed women only get symptoms of late-stage ovarian cancer.

    We are passionate about giving women the knowledge and power to make the best choices for their health. If you think any other women in your life would find this useful then please share with them and hopefully, more women will be armed with knowledge. 

    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.

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  • Can you detect breast cancer in a blood test?

    Can you detect breast cancer in a blood test?

    When a tumour grows in the body some of its cells can break off and enter the bloodstream. These cells are called Circulating Tumour Cells (CTCs).

    The Trucheck Breast Cancer screening blood test uses a ‘normal’ blood test taken by your doctor at the clinic. It goes to the specialist laboratory in Surrey where it is examined looking for CTCs. Even a few CTCs in the bloodstream can indicate cancer.

    A breakthrough study published last year showed the blood test actually performed better than mammogram screening to detect cancers. The blood test found 92% of breast cancer, this was more than able to be detected by normal mammogram screening. We know in real life no test is perfect and there is a small chance of a false alarm.

    The blood test has also shown promising results compared to the GRAIL’s Galleri and CancerSEEK blood tests which only had a sensitivity to detect around 30% of breast cancer cases.

    Crucially the blood test can detect early cancers in stage 1 before there has been any spread to the lymph nodes or elsewhere in the body, and before any lump appears.

    1 in 7 women will be diagnosed with breast cancer in their lifetime. Diagnosing cancer earlier when treatment is easier and more successful is crucial.

    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 Cancer 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
  • How often do you need to have sex to get pregnant?

    How often do you need to have sex to get pregnant?

    How often do you need to have sex to have the best chance of getting pregnant?

    One of the most frequent problems we see as primary care physicians is couples having trouble trying to conceive. As a doctor, something that I find most gratifying is when I do a 6-week baby check having several months before having a consultation with the parents about how to optimize the chance of conception. Most good doctors, when advising couples on getting pregnant, will take a careful medical and lifestyle history to find out if there are any easily modifiable factors that may when addressed lead to an improvement in fertility. Thankfully, most of the time it really is just a matter of time before a couple conceives and the influence doctors have very little to do with it. Statistics show that 84% of couples having regular (at least three times per week) sexual intercourse will conceive within one year and 92% of couples within 2 years. 

    The birds and the bees

    An aspect that many couples find confusing is advice regarding the frequency and timing of sexual intercourse. There are innumerable sources of advice available but many lack quality of evidence or are confusing or contradictory. Knowledge of a few pointers of reproduction can help. Ovulation usually occurs 12 to 16 days before the first day of the next period. The egg lives for about 24 hours. Sperm can survive for up to 7 days. Therefore, for most couples ‘The Fertile Window,’ when the viability of sperm and the egg are at their highest, are the 6 days up to and including the day of ovulation. In terms of timing, the optimum time to have sex is 2 days before ovulation. A common mistake couples make is starting too late in the cycle.

    Little Soldiers

    A commonly held misconception (no pun) is that frequent ejaculations reduce semen quality. In fact, surprisingly, the opposite is the case. A study in 2005 that examined nearly 10,000 semen samples from men who were undergoing investigation for infertility found that even with daily ejaculation sperm concentration and movement remain normal. The same study found that optimal semen quality was found with no or only one day of abstinence from intercourse even in men who had low sperm counts.

    The most recent guidelines on fertility in the UK from NICE (National Institute of Clinical Excellence) advise couples to have intercourse every 2-3 days. This advice on the optimal frequency of intercourse to conceive is based on more vintage studies from 1953 and 1962. These studies suggest that frequent ejaculations might reduce sperm number and movement capability. However, as we have already seen, it has been shown that this is not the case. In addition, another study published in the New England Journal of Medicine also found no evidence that couples trying to conceive should in any way limit their frequency of intercourse. In fact, this study demonstrated that daily sex results in the highest chance of getting pregnant. This is the bottom line. Daily intercourse gives the highest chance of getting pregnant. 

    Don’t Stress

    Trying to get pregnant can be a stressful time and many couples wonder whether it will ever happen.  In particular, intercourse set at a specific time can become stressful and feel contrived. The stress of trying to get pregnant can actually reduce not only satisfaction but also frequency. This is why ovulation predictor kits which require couples to follow a strict schedule can be counter-productive. The most important advice that I could give about trying to conceive is to make a big effort to enjoy the process. Make it fun and exciting. Once you have your newborn at home with you the opportunities for this kind of excitement are considerably less. So make the most of it.

    If you can only manage every two days that is fine as the likelihood of success was almost as good compared to daily intercourse. Leaving it three days without intercourse on the basis of data from 69-year-old studies is more likely to result in a feeling that you are on a strict schedule and make the process less fun. Some couples might find that having frequent sex is stressful in itself and for these couples, ovulation predictor kits may offer a more useful guide.

    Let there be cuckoos…

    More frequent intercourse gives a higher chance of pregnancy and does not adversely affect the quality of semen. So don’t worry about delaying intercourse for three days during the narrow fertile window of 6 days as the guidelines suggest. Throw the ovulation predictor kit in the bin. Do all your going out for dinner, sleeping, and cinema trips (once COVID restrictions are lifted) while you can….. but most of all, please….. let there be love

    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
  • Using Your DNA To Personalise Your Medication

    Using Your DNA To Personalise Your Medication

    Treat. Better.

    What is pharmacogenomics? It is the idea that a person’s genes influence their response to medicinal drugs. This means that by knowing and understanding your genes we can discover the right medication for you at the optimum dose.

    Personalised Medicine

    Many patients do not benefit from the first medication they are prescribed. Some will have side effects. Pharmacogenomics has the ability to make the medicines you are prescribed personalised to you.

    The Benefits of Pharmacogenomics

    The idea of pharmacogenetics is not a new one. As early as 1953 University of Washington geneticist Arno Motulski had established that gene variants affect the metabolism of certain drugs. Our Pharmacogenomics testing examines 50 well-established genes with over 200 gene-varients to establish:

    • What medication is right for you.
    • What is the best medication dose for you.
    • Whether you may experience side effects.

    Getting the Most out of Pharmacogenomics

    The people who benefit most from pharmacogenomic testing are those who require a long-term medication. This is particularly the case when there is more than one potential medication to choose from when the medication carries with it a high risk or side effects, when the starting dosage is undecided, or when patients are on more than one medication.

    Accurate Results

    Once your saliva sample is taken it is sent to the laboratory to undergo cutting edge, next-generation sequencing. The testing has demonstrated 100% sensitivity (true positive detection rate) and 100% specificity (true negative detection rate).

    Contact us to arrange your pharmacogenetics test or find out more here.

    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 Lab Tests & Results 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

    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