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Welcome to the Let's Talk About Women's Health Podcast by UCL EGA Institute for Women's Health. In this new podcast, we will explore women’s health and wellbeing throughout the life course via honest conversations and expert insight, and discuss issues that are relevant to women's wellbeing today.
Zeynep (00:02.424)
Hello and welcome to a brand-new podcast with the Elizabeth Garrett Anderson Institute for Women's Health. Let's talk about women's health. So, in this new podcast series, we're going to be exploring different issues, topical issues, controversial issues, important questions about women's health, inviting expert speakers, but also hearing from different opinions.
And today we have a special edition to celebrate 2026 International Women's Day, Healthy Lives for Healthy Women. And with me, I am Dr. Zeynep Gurtin, based here at the Institute for Women's Health, and I have our director, Anna David, and also Professor Joyce Harper. Welcome, Anna, welcome Joyce. Please introduce yourselves, Anna.
Anna (00:48.288)
Yeah, thank you, Zeynep. Well, delighted to be here. It's a great pleasure to come and join this first podcast. So, I'm Anna David. I'm an obstetrician. I'm an expert in maternal and fetal medicine. And I've been at the Institute for actually really since before it became an institute even it became an institute in 2004 and I started at UCL in 2000. I was doing a PhD all about treating genetic disease in the fetus before birth. And I've been director since 2018. So gosh, that's nearly eight years. Yeah, took the Institute through the COVID-19 pandemic. I work at University College Hospital. So about 40 % clinical, 60 % research, do quite a of education. And I'm absolutely delighted to be here and to talk with you today. Thanks.
Zeynep (01:40.942)
Wonderful, and Joyce.
Joyce (01:43.66)
Thank you, Zeynep. Yes, it's an absolute pleasure to be here on the first episode of the new podcast. So, I've been at UCL since, well, about 1995, 1996. And around that time, we started the first MSC, which we'll talk about later. So, I've been very passionate about education, but at that time in the nineties, I was working on something called pre-implantation genetic testing and was involved with that for many decades doing the lab work, testing embryos for genetic disease, but I've always had a huge passion for educating women about their health. And when I actually first finished my PhD in 1987, started writing a book about women's health, but didn't finish it until 2021! So, I'm glad I took several decades, but I did it. Luckily my next book hasn't taken quite so long, and it comes out in a few weeks. But it's been an absolute pleasure working at UCL and seeing the institute blossom into the great place it is and obviously I love working at UCL. That's why I've stayed there for all of these decades.
Zeynep (02:49.624)
Wonderful. And I should say I'm a relative newcomer having joined UCL in 2018 and I direct our masters in women's health and I come from a sociology background and my research interests are really in people's experiences of reproductive decision making and reproductive journeys. And I think it's quite nice because between us, we've got all bases covered. Anna, you're the clinician. Joyce, you come from a science background and are now really leading the way in terms of education. I come from more of the sociology background. And it's a really important year here at UCL, right? We're celebrating 200 years at UCL. Can you tell us a little bit about why that's so significant?
Anna (03:33.22)
Well, I think it's really important to think about the fact that, you know, this institution was founded in 1826 and it was the first institution, it was the first university in which people could join without having to resort to agreeing with any religious terms, anybody from any background, whether any religion, any country was enabled to go to university.
It was the first university in London. Imagine a great metropolis that London was in the 1820s. And it didn't have a university. Oxford and Cambridge were there, the great institutions. So, St. Andrews was the second university in the UK. But London didn't have a university. Imagine that, a great metropolis with all the business and everything going on. And essentially it started off by people taking out shares in the university. They bought a plot of land. They started off by saying, we found this plot of land. It's on the outskirts of the city. Bought a plot of land. We want to set up a university. And people could buy shares in it. And that was really how it was founded. So, it's tremendously exciting that we are celebrating 200 years. And even then, women's health was a really important part of the university. So, it was one year after it was founded that the first professor of midwifery actually started at the university. So, somebody called David Daniel Davis, he was very famous because he delivered Queen Victoria. We might want to talk about that a little bit later, but there's a long legacy of women's health at UCL.
Zeynep (05:09.955)
Yeah, absolutely. And also, a very long legacy of women's education. I believe UCL was one of the first places in the world to admit women on an equal footing with men in 1878. So, there's a lot to feel very proud of at UCL. I don't want to rush us into the modern day, Joyce, but I know that education is a massive passion of yours. Do you want to say something about the Institute and how the master's programmes at the Institute have started?
Joyce (05:38.572)
Yes, we started the first, well, my first sponsors program with Professor Joy Delhanty and Professor Charles Rodeck back in 1996. So, this year we're celebrating 200 years of UCL, but also 30 years of our MSc. And it only seems the other day that we had our 20-year party, doesn't it Anna! Time goes very quickly, but it's been an absolute pleasure teaching the future leaders and the future…
Anna (05:57.988)
Absolutely.
Joyce (06:08.077)
…people that are going to work in this field. We did start it before the institute actually formed. We were then embedded in the department of obstetrics and gynaecology of which Charles Rodeck was head and Joy Dalhanty was an expert in genetics. So it was, we did a lot of genetics there. The first MSC we set up was called prenatal genetics and fetal medicine. And then in 2009, because of the people that were really interested in the cause, we thought it was really important to cover reproductive science and women's health to reflect then the being embedded within the institute. So that embassy was set up in 2009, that's still running. And then we've had another hugely successful MSc in women, just women's health. And we've also in recent years started the intercalated BSc for the medical students, which is again, women's health, hugely popular. Absolutely again, fantastic to spend a year with these young clinicians who are going to go on and as I said already, the people that become the world leaders and it makes us so proud when we see our alumni as professors and setting up companies that are really changing the format of women's health. It's the most rewarding part of our job as well as being in the classroom and also for me over these decades, seeing how the students have changed. And I always say to them, I'm going to learn so much from you this year because your views and how you think about the issues we're going to talk about are always different. They're changing with every cohort of students. And it's really important for any of us as teachers to listen and be aware of the views of our current students. So, it's a continually evolving area. So, it's absolutely amazing being involved with teaching and it brings, I think, I'll speak for everybody, but it brings us great joy to be the teachers of the next generations.
Anna (08:11.307)
And Joyce, I've been teaching this course since 2000 when I was doing my PhD and I remember helping out on the first one. What I find as well is that not just meeting the students, but how things have changed over the years. So, I teach this prenatal diagnosis and screening module. And in those days, the new kid off the block was basically doing fluorescent in situ hybridisation to have a look at the genetics of the baby. And that was amazing. It was like you could get a result within five working days, which was a complete game changer because before then you couldn't do a genetic test on the baby's placenta or the baby's amniotic fluid. It took about three weeks for the results to come back. So that was then. Now, if you roll it forward, we are now getting that result. We're getting a microarray, which is looking at all the different parts of the genetics of the baby within basically two days but not only that we're also getting genetic sequencing results so we're able to make diagnosis of really rare single genetic disorders in babies where we might have some abnormality and that's hugely changed and then finally with all of that change with all that diagnosis we're now moving into the era where we're going to be actually being able to treat the baby before birth for genetic conditions so it's tremendously exciting and I think teaching on the course makes you see how things have evolved because the questions that I used to be asking, know, the assessments were like an essay about fluorescence, situ hybridisation. Now it's like single gene disorders and therapy and thinking about the ethics and what patients want. And that's where I think the sort of sociology aspect of what you say Zeynep is so, so important.
Zeynep (09:58.956)
Well, I've just actually come straight from the classroom from a day of teaching, and I lead on one of the modules I lead on is called Concepts and Controversies in Women's Health. And really in that module, what we try to do is bring together a discussion of contemporary controversies, interesting questions in women's health with a kind of medical sociology perspective that can offer us concepts to understand that. So today, really interestingly, we started off talking about medical misogyny, where that takes place, where it happens and how we can move into compassionate care and what compassionate care might involve and why clinicians might be suffering from compassion burnout and how the system actually may not be serving clinicians. To be able to be the clinicians often that they want to be because of time pressures, funding pressures, etc. So yeah, we've just had a really exciting day in the classroom, and I have to say leading the...being program director for our newest MSc, MSc in Women's Health, which is multidisciplinary. So, we tend to have people from clinical backgrounds who want to understand more about the social science and legal and ethical aspects of women's health. And equally, we have students coming from more of a social science background who want to understand the medical and physiological basis. And increasingly, we're getting students who might be starting their own businesses and engaged in FEMTECH, etc, and one of the really satisfying, wonderful things is that the students always say to us, you know what, I really wanted to specialise in women's health. I really wanted to get a of a holistic education in women's health. And there's nothing else like this. And I really feel that's true. There is nothing else like that. You know, our Women's Health MSc really does give you the physiology, the science, the sociology, the legal and ethical basis, the research training, the research literacy, to really be able to go on and think about women's health in an analytical, critical way that could then be used in whatever direction you want to take it, whether you're going to policy, whether you're going into research, whether you're going into business. So, it's really exciting to be able to offer that. Anna, can you also say a little bit about maybe the sort of the constitution of our Institute, which is also really, really unusual and our links with UCLH here.
Anna (12:34.998)
Yeah, well, I think, I mean, the Institute basically came about with a collection of departments coming together and bringing in a whole group of experts in women's cancer. So, it was really set up by Ian Jacobs, who came from Barts in East London, where he brought a big team who were looking at women's cancer research, particularly ovarian cancer prediction and prevention. And he came with a team and basically set up an institute which was around the life course approach. And that was really groundbreaking at its time back in 2004 because it was all about the fact that in reproductive health, in life course health, which is about basically family health essentially, having healthy families and the generations of health, it was about the fact that everything links together.
So when you are pregnant, your health and your wellbeing will influence how the baby develops, the baby's born and that is influenced by the birth that you have and the breastfeeding and then as the child grows up, things like adolescent menstrual health, all the gynae problems that people may have, so heavy periods, endometriosis we know is a really big thing and then moving into areas like contraception and then getting healthy if having a baby.
And then later areas things like screening for cervical cancer smears, sexually transmitted infections, prevention of those and then having a healthy menopause as well you know so many women now are perimenopause going through the menopause and then coming out the other side and I know you're going to be talking about that in your book Joyce but yeah over half of the women's population are now menopausal and of course if you have a really difficult time when you are menopausal in your late 40s, 50s, the height of your powers in terms of your economic earning, you are highly professional.
And if women are not able to contribute to society because they're suffering with menopausal symptoms, then that's a big problem. It's an economic big hit. And then also we move on into things like urogynaecology, so incontinence, osteoporosis, and all that. So, the life course approach really tells us about having healthy generations and it was really groundbreaking at the time and was driven forward by Judith Stevenson and her team and particularly thinking about whether we can improve health before people have a pregnancy, thinking about the key things, getting healthy before you have a baby. So, reducing, stopping smoking, stop vaping for example, don't drink, exercising, eating a good diet, that all moves forward into having a healthy pregnancy and having a healthy next generation. And I think these messages are becoming even more important now in our world where we are doing less movement, perhaps we eat more ultra-processed food, you know, and we're probably not thinking so much about generations, but it's a really important area. So that's really how it came together. We have the four departments and we're all about healthy life, as well as disease. So being healthy, how can you be as healthy as possible, and also how can we improve care for you, researching care training if you have some kind of reproductive health problem.
Zeynep (16:10.019)
Yeah, and it’s sort of so crucial to have a place that focuses on that because traditionally, even though it affects over 50 percent of the population, women's health has been marginalised and sidelined. And it seems quite strange that, in 2026, we're still having conversations about the lack of data on women, on women's physiology, on information about sort of women's symptoms with things like heart disease, for example. So, I think, you know, I think one of the things people are sometimes surprised by is that the Institute for Women's Health is not just about women, but women are a huge part of the picture about everything. And so, of course, preconception health you mentioned relates to pregnancy, relates to children, relates to the next generation. So it's actually really foundational about health overall, everybody is health.
Anna (17:05.772)
I think it's very important that also we don't forget that men are a very, very important part of the equation because actually, you know, there is a men's health strategy that's just been coming out now. And of course, being healthy as a man is all about being fit, eating a good diet. We know that if you are a man and you're overweight and you smoke, then your partner who is conceived has more likely to have a pregnancy with complications. And there's all this thing about women shouldn't have a baby when they're much older. Of course, we know that if men have a baby when they're a lot older, so 40s, 45, there is a higher chance of their children having autistic spectrum disorder and a higher chance of single gene disorder. So, I think this whole message needs to go across to everybody who is of reproductive age. Think about your fertility and Joyce you've done a huge amount of work all about fertility education. I think you should come in here and tell us what you've done.
Joyce (18:02.678)
Yes, thank you. And I just totally agree with everything you say. For me, over these almost 40 years, next year I'm celebrating 40 years of working in this area, but it's really become so important to look after our lifestyle. And for me, that's because we're not living the same lifestyle we did 40 years ago. When I started in this field, we weren't eating ultra processed food and vaping and doing all these other terrible things that we do. We were relaxing more, we were sleeping better, but now we live in these such a noisy society where we're bombarded by information all the time, our work-life balance is totally skewed, we're just on all the time, we're switched on all the time, and this absolutely affects our health, it affects men's and women's health. And if for women, we're, well for both, if we're trying to get pregnant, that's going to, that unhealthy lifestyle will have an effect, as you said, on that.
For the perimenopause, it will absolutely have an effect on that. And that's why we're seeing all this increase in mental health issues, the number of deaths now from diseases like heart disease and Alzheimer's and cancer, they're just growing. They're the main causes of death now and that pattern has changed over the generations. So certainly, for my work, looking after lifestyle and educating about lifestyle for women's health has become my absolute top priority. And all those things you mentioned down there, our nutrition, our exercise, our sleep, looking after our mental health and making sure we switch off and don't have burnout and all those things to do with that, but also our friendships and community. So, in the fertility field, this has become a really key area. If we're going to have a baby, you say, preconception health is so important, and we've got to start from a really good foundation. And if we're living this unhealthy life, it's not a good start.
But also, the perimenopause, so many women now want a quick fix to their health. And my argument is there's no quick fix. There's no magic pill or supplement or treatment that is going to get you through any of these key life stages through that life course of women's health in a quick way. We have got to spend time on ourselves, on our self-care and really take time to do this. Otherwise, we are not going to progress through our healthy life. And we all want healthy choices for healthy lives and healthy women. And that's been one of our main themes. And as you said, it's just so important. And we've got to make sure now that we have preventative medicine and not let people get ill and then try and treat them. Because by then it's really rather late, are we seeing increase in infertility and definitely an increase in perimenopause symptoms. So, we've got to make sure we get those messages across, not just to women, to everybody.
Zeynep (21:00.738)
I mean, I think one of the paradoxes that we're living through at this point in time, and Joyce, you sort of mentioned we're not living as we were 40 years ago. We're certainly not living as we were 100 years ago. And there are some amazing opportunities for women's health in that. So, improvements in diagnostics, improvements in treatments and destigmatization of a variety of things. But also, there are a huge number of pitfalls, not least a more sedentary and unhealthier lifestyle. But also, kind of this avalanche of misinformation or disinformation with regards to mental health. And Joyce, you're very big on social media. Do you want to give us your take on that? What's happening? What are the messages people getting about their health and how can they be discerning about what to trust, what not to trust, what is a fad, what's completely made up perhaps?
Joyce (21:53.706)
It is the Wild West out there. Social media has some really good parts. And for me, for education of the public and for my research, it's been absolutely a gold mine. But it is also, as you said, a host of, I can't think of a word. It's just an epidemic of misinformation. It really, really is. And we've done a lot of research on this to try and see, especially how reproductive health is portrayed on social media. And it's the influencers that get the limelight. It's their job. It's not our job to learn all about social media and how the algorithms work and how you get one of your posts to reach millions of people. But these influencers have this knowledge and this experience. And sometimes they get it right. They get the education right. But sometimes they don't.
One term, there's lots of new terms coming out, one's infotainment. So, it's like education, we're trying to give them information, but it's also entertainment. So, we're not very good at entertainment, but we are good at education. So, we do need to move forward in a realistic way. But the information, the misinformation is so believable that I know that many of my clinical friends have such problems with their patients coming in with all this misinformation and then trying to unpick that and say, look, listen to the expert. I'm the expert. This has been my field for a number of decades. You know, I'm going to tell you the right information. And they're brainwashed. They are brainwashed by social media misinformation. So, there's many of us trying to chip away at undoing misinformation, but it's very, very hard. But we also, the health professionals, listen to this misinformation and then they think, that's right. So, then it just escalates in so many ways. So, we've, yeah, I haven't figured out how we undo this and we're spending a lot of time working on it, but.
Anna (24:02.687)
I think one of the ways to do it is really to signpost people to the information that's out there. So, you know, one of the groups that I work with is Tommy's Charity and Tommy's Charity has an absolutely fantastic helpline, telephone line. It's manned by, I should say, staffed by midwives, experts who know what they're talking about. And so, I think it's about trying to find the right place with trusted information. The challenge is actually to produce trusted information takes a lot of time and energy. You've got to make sure that your information is correct, that you are providing it in bite-sized pieces, that it's really understandable to everybody. So, Tommy's is great, and I'm very happy to pitch it and say, go and have a look at Tommy's because they're all really very, very, very good.
But other areas, so for example, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, they produce patient information leaflets and I very often just signpost people to that because if you want to know the real numbers about something and that's what I think that is the data. The data is key, the numbers are so important, it'll give you the numbers and quite often sometimes patients will come along and say, well, I know they'll come along, and they'll bring all this information that they've got and I'm just like, well, actually, let's have a look at the data. Let us download the paper that is published about this particular thing. I will print it off and I will highlight it and give them the numbers because data rules. And actually, if you've got the data, you are as educated as I am as a clinician. And I think that that is one of the ways that we can really get through to people is that get information that is from a trusted source. Otherwise, you really don't know where it's coming from.
Zeynep (25:52.035)
I mean, that's what you've just described there, Anna, is a really amazing clinical interaction that, you know, that you could take the time to talk your patients through their concerns, take them to the source of the data or of the information. But I think often times there isn't really the space for that. And I think certainly from a sociological perspective, in certain spheres at least, part of the problem with individuals trusting social media or influencers is that there has sometimes been an erosion of trust in institutions. You know, that erosion of trust has sometimes been for very valid reasons, you know, where individuals have repeatedly gone to a doctor, had their symptoms minimised, had their experiences not believed, there's been too little time. And also now, next to the social media piece, what we also have is a burgeoning commercial sector, where perhaps you are able to have more time or a more sort of fancy interaction, I suppose, but you can't necessarily see the financial arrangements taking place behind the scenes. So, it's also very difficult for patients. They have a lot to try and navigate and to try and think about. And I think it's also understandable that in some cases, social media gives people access to sort of very valuable communities, particularly the kind of focus of my work where people going through assisted reproduction, for example. Some of the communities for trying to conceive, for example, some of those online communities have been incredible at destigmatising people's experiences and giving them a sense of community and giving them a space for making sense of their feelings, their emotions, their symptoms. So, it's a really mixed bag and it's difficult, isn't it? What would you guys both say? I'd love both of your take on. What are some of the really critical questions for women's health? What are either critical questions where there is a lot of misinformation or where there is no consensus, where the data has really not led us to a consensus yet, or these are emerging issues, so perhaps we don't have enough research. What are areas that are really kind of at the cusp of debates about women's health? I'll take you first, Joyce.
Joyce (28:25.55)
So, for me, my two main areas I work in is fertility and menopause, but I do cover the whole of reproductive health. Just to say one more thing, following on from Anna, I always signpost everybody to the societies. I've done so many reels saying, please just listen to the societies. If you want something about menopause, listen to the Menopause Society. In 2019, I co-set up with Karen Hamburg, the International Reproductive Health Education Collaboration. And we work with ESHRE, the European Society of Human Reproduction and Embryology, who are a hugely trusted society. We only have published evidence-based information. And we have co-designed information leaflets, information and teaching aids for teachers to use in schools, and evidence-based co-designed fertility education poster. So, trusting those societies. RCOG is brilliant. The British Menopause has got an arm the women's health concern that's for the public.
So again, yeah, I agree. And I always tell people to go to the societies. do not, they're not selling anything and then, and they're not making things up. They really have had people like us who have sat down, looked at the data and given the current recommendations that we can use at that time. But the menopause for me is the most worrying. So, one example, looking at the commercial aspect, I've been doing a lot of work on supplements that are being really promoted for women to use. We have looked at menopause supplements and we're looking at the moment at fertility supplements. The fertility supplement market doesn't seem quite as complex as the menopause, but the menopause we looked at over 200 supplements marketed to the menopause. And I was just so sad that I couldn't see the logic actually in any of them. The British Menopause and International Menopause Society, for example, recommend that vitamin D is one of the recommended vitamins that women take at this time. Actually, you should all be taking it, but it is a recommended one. And only 54 percent of our menopause supplements even had vitamin D in them. But they're being heavily marketed as really the elixir of life.
Apparently, they're going to cure all of menopause symptoms, make you looking young and youthful, improve your sex life, improve everything, weight loss, everything apparently with one supplement, which is not true. So, for me, it's actually the mis-selling of things like supplements and treatments. I've had this in the IVF field for decades as well. I've done a huge amount of work on IVF add-ons, which again are unproven treatments that are being used. For me, my biggest problem in both of these areas are the use of unproven supplements and treatments that are being heavily sold. And unfortunately, what we're seeing now is a lot of medics who are promoting them as well. And that's a huge conflict of interest. I don't understand how the advertising agencies allow this. I don't know how they allow any of it, but especially not clinicians getting involved and putting their name to some of these products. I think for women at the moment, that's my biggest concern that there's incredibly brilliant marketing or as I call it brainwashing, where this supplement or potion or lotion or treatment is going to help you improve your health. And unfortunately, in almost everything we've looked at, there's no evidence at all that it will do that. Again, as Anna said, going back to the data, going back to the research studies, they are our gold standard. And as scientists and clinicians, that's what we do. We look at that evidence and things are being sold to women with no evidence. It's, I find that the most hugely upsetting part of women's health at the moment.
Zeynep (32:25.984)
Yeah, and that really relates to the thing, one of the things that I'm really concerned about, which is a kind of cultural pathologisation of ageing for women, whether that's, you know, in beauty standards or with regards to fertility or with regards to menopause, you know, this kind of almost entrenched idea that women should forever be in their prime, which is presumably sometime between early 20s and early 30s or something, which is, you know, it's completely impossible. And it sets these bizarre standards for women to try to mould themselves into. But Anna, what would you, what would you like to have a rant about?
Anna (33:10.355)
Well, I would say I'm definitely still in my prime, Zeynep. I think you have to check, you have to sort of see how you are in different parts of your life. You know, if I look back at what I was like in my early twenties, I was sort of a bundle of nerves, thought I looked awful, thought I was overweight. You look back at pictures, and you think, wow, I was gorgeous. I was active. I was amazing. And you just don't get it. And I think when you get older, I remember my mum was always a bit like, actually, when you get to your 70s and 80s, you don't actually care anymore and that's great. So, you just don't, you're just like prepared to just go for it.
And I think as a woman in a sort of, you know, in a field where you're in science, I think one is much more likely just to say, you know what, I'm just not going to listen to this. I may be the only woman in the room, but I am just going to stick my head above the parrot and say, I'm going to speak my truth. And I think that, I think that is something that you get as, as you get a bit older. So, I would definitely still be in my prime when I'm in my 90s like my mum was.
But anyway, yes, what's my bug bear? Not a bug bear, but I think we are going to really have a big opportunity and a bit of a breakthrough in one of the huge issues in maternity, which is how do we work out if the baby is okay in the womb? It's a massive problem and of course it is generating all of the concerns that women have. Women are now choosing not to have a vaginal birth for some very good reasons because they're frightened about what they're hearing in the press, they're frightened about the fact they might not be well looked after. I think a lot of the time that's the story that they hear and they don't hear all the really good stuff like the fact that the stillbirth rate overall has gone down, we are, you know, baby outcomes are better. Yes, there are disparities. Yes, okay, there are issues, but actually overall, you know, it's safe to have a baby now. If you look back to when Queen Victoria was having her baby, it was jolly dangerous. It was really dangerous for you to have a baby in those days. And of course, now what we have we've been we've been using heart rate monitoring for many, many years. The first heart rate of the baby was done at UCL in the 1950s. The first ECG, the first cardiac monitoring, so cool I was investigating this, was done in the 1953 at UCL, which was pretty amazing. But the actual just listening to the heart rate came in the 1970s as this was going to be this wonderful way we're going to be able to cure and prevent stillbirth and all this kind of thing. And it just didn't happen because what people have been doing is listening to the heartbeat and trying to tell us about how the placenta is functioning, the placenta is being supporting the baby. And of course, what we really need is something which is going to monitor how the placenta functions. So, it's really exciting that we've got some great research coming up at UCL all about that. And it basically is working out whether we can shine a light through the skin of the tummy, through the wall of the womb, into the placenta, and that bounces off the blood cells and actually tells us about the oxygen level and more importantly tells us about the function and metabolism of the placenta.
So, I think we are going to be in the next 10, 15 years, I think we're going to be seeing huge progress, which is going to reassure women and men all about what their baby's doing, how is their baby functioning? And we should be able to say, actually, okay, your baby's a bit small, yes, rather than inducing your labour, let's do this test, which is simply shining a light, have a look at the oxygen level, have a look at the placenta function. Do you know what? Your baby's fine, you can carry on, it's safe for you to have a vaginal birth and that's going to be a really big thing because at the moment we're relying on a rubbish test. It's the only test there is, it's a gold standard test but it's just not gold standard at all, it's really not very good.
Zeynep (37:09.537)
And presumably these things are becoming more important as we're having an older age of maternity, as we're having fewer babies, you know. So, I guess some of these concerns are becoming more pronounced for the kinds of patients that you're seeing.
Anna (37:27.455)
Well, absolutely. So, you know, the average age for having a baby in the UK overall is now 30.9 and the average age at UCLH is about 34. When I started in obstetrics in 1990s, the average age was about 24 and the average BMI was 25. And it does make a difference. I mean, yes, OK, if you don't find your partner or you're busy with your career, that's fine. But we're now seeing many more women who are choosing to have a baby older. Perhaps they have had difficulties conceiving and they may have had to resort to a donor egg where they're using somebody else's egg and we know that those pregnancies have a higher chance of complications. There's nothing they can do about it; it is what it is and all I can do as a high-risk obstetrician is to help them do that. I can monitor their baby, I can give them low dose aspirin, I can monitor the size of the baby but really, I think this is going to be a huge benefit for those people who have got more complex pregnancies and people are more likely to get pregnant now who maybe didn't in the past. We now, know, women with diabetes pre-pregnancy are more likely to get pregnant and have a successful pregnancy outcome, whereas in the 1980s it was really quite difficult to have a successful pregnancy when you were diabetic. So, I think it'll really change what we do but it'll take time to get going with the research and implementing it and trialling it out.
Zeynep (38:52.961)
I think this is also another area in which there is such an interesting and complex interaction between what's happening sociologically and the social structures and how we're seeing that interact with women's health on a physiological level. So, we've obviously mentioned the rising age of maternity and birth. A huge part of the reason for that is because the structure of our society doesn't make it very easy for people to feel ready for parenthood at a time when, you know, their parents' generation might well have done so. And that's related to all sorts of reasons, not least of which is, you know, the cost of living, the precarity of jobs, the difficulty about getting on a housing ladder, you know, these steps that traditionally we've thought about as being necessary preparation to become a parent. All of that's been pushed back for various social and structural reasons and it's affected some groups obviously much more than others. But of course, our biology hasn't changed in the meantime. So, it's not like, you know, biologically we're sort of entering the menopause 10 years later. So, we've got this kind of difficult period haven't we for women. I mean, I had my baby, my two babies in my 40s at UCLH and nobody battered an eyelid I think. I think they were all very used to it.
Anna (40:26.942)
That's normal. Yes, you know, when I first started as an obstetric consultant at UCLH in 2008, I ran with Melanie Davies, the older mother's clinic, and it was 40 and above. And we set it up because we knew that women were coming along who were older and they were a very special population. They often have got underlying medical disorders. They've taken a long time to get pregnant. Many of them have had to have gone through artificial reproductive therapy techniques: IVF, ICSI, all of this kind of thing. It's cumulative. And you really do need to have the time to spend to talk to people. And actually, it was at the time that I realised there was no good data about what we should do. There was this question, everybody used to come in and say, should I be induced early? So, I worked with the Royal College of Obstetricians and Gynaecologists and we wrote our first, the scientific impact paper all about, you know, advanced maternal age, what are the risks, what should you do? And identified that there were, you know, what's the best guidance? Yes, there is an increased risk of stillbirth when you are older. It is what it is because the placenta is an organ that wears out quite quickly at the end of pregnancy. And so, it's probably there is a risk. But of course, you just need to know what is that risk compared to somebody who's in their 20s, where the risk of stillbirth is around the same if they're at 42 weeks, two weeks overdue than if they're at 40 weeks when they're 40. So, you give this information to people. And it was really good to see that.
Now we've got women who are 45, 47, in their early 50s and you just have to say, yes, we are where we are, there are risks, but actually overall people who are that age will have a healthy pregnancy, but it may not be quite such an easy journey. Go with the flow. Because actually when you are an older mother, you are often much more able to cope with the ups and downs and the fact that you're going to be up all night with a baby that's crying and you're sanguine about it. You go, well, you know, I've coped with other things that are difficult. I've waited for this for a long time. I've worked at it. I deserve it. So, I think in some ways there's good things and not so good things about having a baby when you're older.
Zeynep (42:39.713)
I mean, I think one of the things you said there, Anna, that's spot on is that, you know, we've got this sort of over simplistic idea about older motherhood, which is that women who've wanted to focus on their careers and have left it too late. And, you know, in the interviews I've done with older mothers, women over 40 who are having babies, for most of them, it hasn't been a choice. This hasn't been their ideal timing. And in, you know, pretty much nobody said I'm having children at this age because I was really focused on my career. Instead, what people said was I didn't have a family for various other reasons, either I wasn't with a partner or my relationship broke down. So of course, I concentrated more on my work because I was able to, you know, the relationship was the other way around, but you know, these kinds of ideas persist that
like to pigeonhole women's decisions. And certainly, for me, it was, you know, this very lengthy journey, not through choice. And I was very, very lucky to be able to access lots of medical advances that would not have been possible. Certainly, you know, 40, 45 years ago. But what I really feel the pressure of now having very young children is really kind of the next piece of the puzzle, which is being healthier for longer. And I think you know, that's becoming something that's really, important to a lot of women. And I think this segues beautifully Joyce into the topic of your new book. Would you like to tell us a little bit about it? Because it's so important.
Joyce (44:09.486)
Yeah, so my last book was all about the journey from puberty to menopause, so your fertile years. Whether you wanted children or not, I wanted women to know this information. And the reason I wanted to write that book, and I started it in 1987 was because when I started as a clinical embryologist in my first job after my PhD, I had two degrees and I realized I did not understand how my reproductive system worked. And I was astounded that I, why didn't I know that? If I don't know that, how do my friends that did other subjects know anything about their body? So that's really been an underlying passion of mine for all of this time. But I really wanted to look at aging and healthy aging. And I was, I was very aware of the last 10 years or so that lots of people I, the women I come into contact with are thriving, but there are lots who are struggling. There are women who are struggling when their children leave home. There are women struggling with either their career and whether they retire and what they do and their sense of purpose, but also some women who haven't worked, they've been looking after children, haven't worked and have now got to this time of change. So, menopause is a really big time of change for women. And it does change women. It makes many women reevaluate their life.
And I think it's an opportunity for women to think, what do I really want to do? And we have to face it that around about the age of 50, we've got probably 20, at a stretch 30, unless we're Anna's mother, 20 or 30 healthy, good years left. There are exceptions and I love people like Anna's mother who really are thriving at this stage.
How can we help those women who are struggling? So, what I did, I didn't want people to just listen to me, I want women to listen to other women. I think sisterhood more than ever at this time of our lives is really, really important. So, I decided to interview 50 women who are all beyond 50, the oldest was 75, who were thriving and happy and share their words of wisdom. And they've had ups and downs, they've had struggles, and some of them are still having struggles. None of us are perfect. None of us are happy all of the time. But their wise words certainly changed how I live and my view of the world. I really am enjoying every day now more than ever. And I just really hope that their wisdom can be read by women who are struggling and give them some tools for their toolkit of how they can, as I said, back to that word self-care and they can improve all their pillars of health. So how can they improve their nutrition? And exercise, I've got a real thing about exercise. When I was doing my PhD, I actually trained as an exercise teacher. I did the, can't, my God, it's gone out my mind now, well it's cool. other, yeah, well like J-Fo, it's the YMCA. It was, I did the exercise to music course. It was quite tough.
Anna (47:16.337)
Was that Jane Fonda?
Joyce (47:27.448)
We had to do lots of things and teach a real class and get assessed. But I did that and taught fitness for many years. So, I've always have been very passionate about it. And as we've said already, it's important when we're trying to get pregnant for both the man and the woman to have some exercise. It's important for reducing chronic health conditions. It's important to help us through menstruation and through menopause and to live healthily. When we get to 50, we really realize it's now or never. We've got that 20 or 30 years left. We've got to make a choice. And I do feel very sad when I hear so many women who are still not finding the time or they're feeling that it's selfish if they spend time looking after themselves. And I've got to look after everybody else. We haven't, we've got to look after ourselves first because we are aging and things are going to get more difficult. We're going to get more diseases. We're going to get frailer. We're going to get less mobile. So, the only way we can do that is really, now read the book. It's enlightening. We're going to be enlightened by it. And it's our choice. It becomes our choice.
So, I hope that women find the time, but I hope this message gets to younger women. I want this message to be in schools that when I recorded one of my podcasts with the chair of the Royal Osteoporosis Society, Neil Gittos, he said that we are laying down all our bone, but before we get to 25. And women do less exercise than men at every single age. And if young girls know, teenage girls know that they are not just exercising to look great, they are exercising to really help all of their health, but laying down their bones, their healthy bones in these teenage years. I've never heard anybody tell somebody that. We need to get these messages out there that this is going to help with all of the stages of their lives across the life course. So, I have become rather fanatical about making sure women are really getting these messages across and the book is just full of it and other women's words of wisdom.
Zeynep (49:38.283)
What are the pillars of health Joyce, I know your book is structured around…
Joyce (49:42.958)
So, nutrition, yeah, so I've got, in my book, I've got pillars of health, but also pillars of happiness, which I think are really important. The pillars of health, again, are nutrition, exercise, sleep, mental health, friendships and community. We have lots of data about friendships and community and not being lonely, absolutely reducing chronic health conditions. Loneliness is a killer. And as we get older, women can become, everyone, men and women can become more isolated, and this is really not good. But we've also got the pillars of happiness. So, we've got hobbies and creativity. We've got sex and love. We've got sense of purpose. We've got time in nature, travel, adventures. All of these things release happy hormones and they reduce cortisol. And cortisol is getting a exposure at the moment. Apparently, we can have cortisol belly and all, which is not a thing anyway, but you can see on social media. But anyway, so, what we do need to do is reduce, reducing cortisol is important, but releasing those happy hormones and they are so good for our immune system, for our heart health, our reduction of again, chronic health conditions. We need to take these things on board. So, self-care is the one thing I will tell everybody.
And we have International Women's Day coming up very soon. On the 8th of March and we have a number of events from the Institute, and they are all about healthy choices for healthy women. So, we really want to be sure that women experience this. So, I've got my book launched, we've still got some tickets available, they're all free events, that's Friday the 20th of March. We're going to hear from some of the wise women I interviewed, also have some dancing with a wonderful DJ, Rosie. We've got an event with my wonderful friend, Nighat Arif, on Liberation, The History of the Pill. So again, there's still some places available for that. So please register. Everyone is welcome. The public are very, welcome at these events. And we've got one with about gender differences in women's heart health with some brilliant experts from UCL who are going to talk to us. That's at lunchtime. And both my event and this heart health event are hybrid. So, if you can't make it in, you can listen online. And then we've got on the Thursday, the 19th of March, we've got Back to Basics, re-centring women's health in the age of big tech. So again, please come to that. And you can access all these on the Population Health Sciences and Women's Health website. If you just put Institute for Women's Health, Women's Health, International Women's Day events, you'll come to them, but they are on our social media as well.
Zeynep (52:35.615)
Yeah, thank you so much Joyce for clearly outlining all of that. And I think it's one of the really nice things since I've joined that I've really noticed about the Institute for Women's Health is every year, there's a whole range of events for that whole week of International Women's Day that really spotlights different issues about women's health. What are you most looking forward to, Anna?
Anna (52:58.448)
Well, I'm looking forward to hearing Nighat Arif talk about development of the pill, but also thinking about the impact of what having really effective contraception has done. But it's contraception which actually women have had to be the drivers of. They're the ones that take the responsibility for having or not having children. And I think it's interesting how it's become very much part of women's health is that you're the one in the partnership that is sort of the keeper of the next generation. Is that fair? I hope she's going to be talking a little bit about that. Why is it, I mean, yes, it's difficult for, the people have been trying to develop contraception, effective contraceptives for men and they are out there, but actually the question is whether men want to use them and whether women perhaps trust them to use them properly. I mean that's really interesting, sort of trust issues.
But of course, now we're moving into a time where women are thinking, well actually do I really want to take hormones that is effectively going to affect my sex drive? Is going to be perhaps I might have weight changes, I might have mood changes, I might have skin changes and people are now moving away from that very much and thinking more about sort of holistic ways of actually accessing their information about their menstrual cycle. I think that's where it's really great to see. I've been reviewing as part of UCL 200, going back and looking at all of the history of women's health at UCL. And one of the big people who developed supporting families and parents learning about pregnancy was somebody called FJ Brown, who back in the 1920s, he developed the first family planning clinics and first parental, you know, antenatal clinics. They had antenatal clinics and they trained parents; they talked to patients and people after birth about contraception. I mean, wow, that was pretty something in those days. So, I think we've got a long legacy of educating the public, educating patients about people having families, about their reproductive health.
And, but of course there are consequences to having control of your cycle, which we are seeing, which is of course that as people, they might not think about their reproductive health, they don't think about their fertility journey until perhaps it's getting quite late and they're a lot older. So, we've got to explore very much this legacy and I hope Nighat is going to talk about.
Zeynep (55:37.266)
It's going to be an exciting week.
Joyce (55:37.56)
Can I just add that, so I have three sons and I know they would definitely like to have the control over their fertility and take a male contraceptive. So, I think we underestimate men. I don't think it's about whether we trust them or whatever. I think they want to be empowered with their control, and they've never had that opportunity. So, I hope Nighat does talk about that. I did an event years ago; there was a comedy show called Comedians Give Lectures. And the comedian I had was giving a lecture, a funny lecture about male contraceptive. And I was the expert that had to say, and yeah, I think that we need to give men the option to have control. They have trust issues of women. So, they want to have control. So, we should empower men with a male contraceptive. I think it's a big injustice to men's health that they have not got better contraceptive choices.
Anna (56:44.743)
But I think we need to also talk to the drug companies are developing them because they are there. They are there have been actually developed and they are reasonably effective. But it's whether, perhaps things are changing. Maybe this new generation who want to have more control. I mean, you want to understand a little bit more and perhaps want to take some of the responsibility, or perhaps all of the responsibility in a partnership. So, yeah. Okay, anybody out there, any drug companies out there who are listening, please get in touch. We would love to talk more about this area because I think it's really important that that men need to be involved in these discussions and please, if you're thinking about funding fertility research into male contraception, yeah, we're interested at the Institute.
Zeynep (57:17.877)
Yeah, I mean, it's a really interesting question, isn't it? Because on the one hand, we're talking about control, but on the other hand, it's also a responsibility and, you know, having to take things for your body. So actually, the more people have that choice, the more everybody can, you know, make an informed choice and decision about what it is that they wish to do, or whether their partner wishes to take contraception or whether they wish to take it. Yeah, great. So many interesting things. I feel like we could talk for another hour guys, but we've come to the end of our hour, and we should probably curb ourselves! I want to end with a really quick question to both of you which is that what would be your one health, women's health, or health tip that you would give to your younger self?
Anna (58:25.061)
So, I would say that it's really important to exercise and I would say not exercising like playing a sport or whatever, just exercising, find something that you enjoy. And I learnt how to run in my mid-fifties. It's embarrassing, but I think you have to learn how to run. You have to be taught how to run. And I did a running course. I always thought, I couldn't understand, so my oldest son is five-foot, six-foot two, and he runs and he's chit chatting away and I used to huff and puff after him. I still do huff and puff, but I do I can keep up with him and I basically did a running course in my 50s because I thought you know what I really do need to know how to run properly and obviously doing the wrong thing and it was very simple they said well you are running sort of, you're not really running very well because you don't actually lift off the ground and the reason is because every time you put your foot down you break. So, I was running and breaking, and running and breaking, and that's why it was so completely exhausting to run. So, I did a course, and it was transformative. I ended up being able to run properly. The before and after videos are hilarious and I think I would say go and do a running course, because you can run, you just need to be trained how to do it.
Zeynep (59:45.501)
How fun! Well, maybe there's hope for me yet! Maybe that's what I'm doing. Maybe I'm just breaking all the time. And Joyce, what about you?
Joyce (59:55.118)
Well, I asked people a similar question at the end of my podcast, and I've also asked the women in my book. And some people give something very specific to themselves, but some people give it to the younger generation. So, I'm going to do, I have done my personal ones in the past. You can listen to them at my podcast, but I'd like to give one to the younger women now who are coming up. And I would say we are all very individual and there is no one size fits all. So, for your health and happiness, what I think they should do, we have these complex menstrual cycle that our body goes through from puberty to menopause, and various factors will affect how we feel at different times of the month, for sure. Absolutely. I've done lots of research on this. Women feel different at different times of the month. So, I would say that monitor your day-to-day life. You don't have to do it for a long time. You don't have to do it forever, but see what affects you.
So, for some people, for example, alcohol will really affect their sleep and they won't sleep so well. For some people, eating late will affect their sleep. They won't sleep well. For some people, this particular exercise doesn't work for them, but they might not realize, and they might just be powering through this particular food or how they might relax. Are they relaxing enough? So, I would say, you don't have to use an app, but I would say definitely monitor your day-to-day lifestyle, how you're feeling, and really understand yourself. So, we're running a menopause education program. We're calling it InTune, because we want women to be in tune with their bodies and in tune with their menopause and in tune with each other. And we are all very different. So even if you've got a sister or mother, you're not going to be the same as them and you're not going to be the same as your friends. So, figure out how your body works optimally and how it works in relation to your different lifestyle events.
Zeynep (01:01:55.866)
That’s another great tip, and you know what I did once, I think I was about 24 for a three month period I kept something called my body book and I just wrote everything down on it how I felt in the morning you know, just lots, and actually those three months taught me so much about myself and you know and recently I've just read a medical paper that links various things and I was like I knew that - that was in my body book. So yes, I am inspired now to go on a running course and to do another three months of my body book 20 years on. It's been such a pleasure talking with you, Anna and Joyce, and it's been such a pleasure kicking off our new podcast. And I hope we'll get to have lots of interesting conversations. Thank you for being on the pod.
Joyce (01:02:42.862)
Thanks, Zeynep.
Zeynep (01:02:44.372)
Bye.
Anna (01:02:45.371)
Thank you.