About the Lecture:
Understanding reproductive health is key for everyone, whether we want children or not. Since writing a book called Your Fertile Years, Professor Harper has been researching into all aspects of reproductive health education and heads the International Reproductive Health Education Collaboration who aim to deliver reproductive health education to everyone. She created a survey to ask teenagers around the world their attitudes and knowledge to reproductive health. So far data has been obtained from the UK, Belgium, Greece and Japan. And she asked UK teenage girls how they feel about having a period. She has also surveyed over 6000 women to ask their attitudes and knowledge of their periods and menopause. Through this research, resources have been created to help teachers and health professionals provide education and she is heading the development of the UK Menopause Education and Support programme, so that all women in the UK can understand what happens during menopause.
About the Speaker
Joyce Harper, Professor of Reproductive Science at UCL
Joyce Harper is an award-winning educator, author, podcaster, academic, and scientist. She is Professor of Reproductive Science at University College London in the Institute for Women’s Health where she is Head of the Reproductive Science and Society Group.
She has worked in the fields of fertility, genetics and reproductive science since 1987, written over 240 scientific papers and published three books.
She is leading the development of a UK Menopause Education and Support Programme with support from key organizations.
She is co-founder of the UK Fertility Education Initiative (www.fertilityed.uk) and founder of the International Reproductive Health Education Collaboration (www.eshre.eu/IRHEC). She is working with schools in the UK and globally to help deliver reproductive health education.
Her latest book, Your Fertile Years, What you need to know to make informed choices, was published in 2021 by Sheldon Press.
Her podcast is called Why Didn’t Anyone Tell Me This? Is available on all podcast channels.
Further information – www.joyceharper.com
Follow on X (formerly Twitter), Instagram, Tiktok and Linkedin – @ProfJoyceHarper
Well, it’s my pleasure to welcome you to this UCL Lunch Hour Lecture on why we need to teach everyone about reproductive health. My name is Howard Clark, I’m professor in Neonatal Medicine and Child Health at UCL and Deputy Director of the Institute for Women’s Health, and I’m going to be chairing today’s lecture.
I’m going to introduce now Professor Joyce Harper, who’s our speaker. Joyce Harper is an award winning educator, author, podcaster, academic and scientist. She is professor of Reproductive Science at University College London and the Institute for Women’s Health, and she’s head of the Reproductive Science in Society group.
She’s worked in the fields of fertility, genetics and reproductive science since 1987, and has authored over 250 papers, published three books. She’s leading the development of a UK menopause education and support programme with support from key organisations. She’s also co-founder of the UK fertility education initiative,
And founder of the International Reproductive Health Education Collaboration. She’s working with schools in the UK and globally to help deliver reproductive health education. We will have some time at the end of the lecture for questions. These can be submitted at any point during Professor Harper’s talk
By going to Slido and entering the code hash, reproductive health. So now it’s my pleasure to hand over to Professor Harper for her talk. Thank you, Howard, for that lovely introduction. Welcome, everybody. I believe we’re live streaming on YouTube so I’m hoping that all your tech works.
I’m now sharing my slides. Hopefully, you can all see those. So we do we need to teach everyone about reproductive health? So as Howard said, I started working in this field in 1987. And at that time, I was around about 25 and I was trying not to get pregnant.
I was really aware that so many of my friends, as I was learning things about fertility, as I started working in the fertility lab. And I started writing a book about fertility, but I was just new to the career and it was quite a new information I was taking into my life.
So life goes very quickly. And we roll on now to 2015. I finally thought I think I need to finish that book I started in 1987. So my book is called Your Fertile Years, and it was out two years ago.
I’ve also started a podcast last year called Why Didn’t Anyone Tell Me This? Because I’m absolutely passionate about the need to teach everyone about reproductive health. So just some disclosures, I do get paid to do some work for the companies listed here, either paying conference fees, or travel or consultations.
So what I’m going to cover today is why this is important to everybody on this call. I’m going to give you some information about the study that I did with schools, then talk about menopause, and what our international group is doing to help educate everybody.
Then I’m going to do a very whistlestop tour on what I think you should know, at least some of the basics that you should actually know. So, as I said about my podcast, it’s called Why Didn’t Anyone Tell Me This because it’s something I hear so much from the public.
They didn’t know this, they should have been taught this. We are really talking about reproductive health. Sometimes I’m going to talk about fertility, but it’s not just about having children. We’ve all got a reproductive health system and we need to know how to keep that healthy.
Also these are not just women’s issues by any means. So let’s start with some global data. The mean age of women and men at the birth of their first child has been going up increasing every year that data is collected.
So if we look on the left hand graph, this is the data for women. The black diamonds are the data for 1970. The white diamonds are for 2000. Then the blue bars are 2020. When I first started doing this similar talk, the upper age limit of this graph was 32.
There was no country that was above the age of 32 at the age at first birth of the woman, but this has now gone up to 34. If we draw a line from age 30, we can see most of the countries now, the age of first birth is over 30.
I want you to remember the age 35. I’m going to come back to that later, but basically at age 35 or mid 30s, women’s fertility starts to decline and many people here are getting very close to the stage when their fertility is starting to decline,
And as you’ll see, this will affect the size of their family. And for men, it’s also been going up, it was exponentially going up, it’s sort of plateaued a bit now, but certainly hovering around the age of 33. Now, the total fertility rate
Is the average number of children a woman will have in each country. So if we just take this data for women, this will obviously reflect on men as well. They work this out by the average age of women when they’re fertile, and how many children they have.
Now, when I was young, in the UK, it was 2.4, we had 2.4 children, and now it’s 1.56. If we look globally, it’s gone down from in the 1950s, from 5.4, to 2.3. In the EU, we can see several countries there. If we look at the bottom, countries like Italy and Malta,
They’re basically having one child per family, and the lowest in the world is South Korea, at 0.84, and in Seoul, it’s 0.55. I’m going to show you some data that we’ve collected on asking people how many children they want.
You’re not going to be surprised that most people do want to have two to three children. But they’re not having that desired family size, as we can see from this data. And in the UK, 20% of women are childless. Now, some of those women will have chosen not to have children.
But there’s a big proportion that are childless not by choice. Data has shown us through a number of big research studies from around the world, that a lot of the problem that comes from the fact that there’s a lack of public understanding of fertility.
So back in 2015, when I was writing my book, I was part of the British Fertility Society executive. Myself and Adam Balen, and Adam is actually with me today, I’m at the RCMG conference for the International Women’s Day. Hence, these pictures. This is one of the past presidents.
Adam Balen and myself were having a chat over coffee one day at a British Fertility Society executive meeting, and we said we need to form an initiative and start educating the UK public about fertility and reproductive health education. One important thing that we contributed to
Was a consultation document from the Department of Education that said, we now have this in the curriculum, saying that we need to teach the facts about reproductive health, including fertility, and the potential impact of lifestyle on fertility for men and women, and menopause. Since 2019, this has now been in the UK curriculum.
I think, actually, we are probably the only country in the world that’s even included the word menopause in any education curriculum. We are really moving forward in the UK. But I was aware, even though we had the UK group, I was very aware that we have amazing people globally,
Who have been working on reproductive health education for many, many years, some of them decades. So I love getting groups of people together who know more about something than I do. We work together collaboratively to move something forward. Trying to develop evidence based international reproductive health education is a very, very tall order.
Some of the countries we’re working with don’t even teach sex education. So we’re coming from a level of zero in many countries. So we’ve done a lot of work. You can see our publications here, and we have a website, you can just Google us
And you can find out where we are and what we’ve been doing. So as I said, this is not just about fertility education, it’s about reproductive health education. This is the list of things I think that you should all know. So on Slido, if you could let me know,
Where you taught about any of these topics when you were at school. So from puberty, right through to menopause, cancers, reproductive cancers, wellbeing, etc. So for me, this started about 10 years ago. I thought I need to go to schools and talk to them about what they’re teaching their students,
With my list that I showed on the previous slide. I learned very rapidly that they’re not teaching these topics in biology. Some of them but not all of them are taught in what we now call, it’s been called many things, but at the moment it’s called PSHE,
Which is personal, social, health and economic education. I’ve been giving lots of lectures in schools, getting lots of interaction with the students, interaction with the teachers and finding out what they want to know and how we should move this forward. So what we did first of all,
Was that we looked at the UK curriculum in detail. We published two papers that you can see here, all of the papers that I’m going to show you in my talk are open access. Just put the title into a search engine, and you’ll be able to get access to the paper.
We really realised that the UK was falling through the gaps. We were not teaching many of these key topics to lead to reproductive health in UK schools. So what we did next was developed a survey to our 16 to 18 year olds to tell us what they’ve learned,
And also their attitudes to family building and reproductive health. We published two papers very recently on parenthood intentions and what they’ve learned. I’m going to show you just a couple of graphs from that data. It’s great with our global team, this survey has been repeated in Belgium, led by Ilse Delbaere,
And we are very close to publishing the first paper from this. We have also been doing this led by Mara Simopoulou, in Greece, and with Eri Maeder, they have repeated this survey in Japan. We are now comparing this excellent data. So a bit about their intentions.
There was lots of very rich information there. But just a couple of things. We asked them what age they would like to have their first child, and it was from about 26 to 35. We asked them how many children. As I said, two to three was the most common response.
We also did ask them a question before this, actually do they want to have children. It was interesting to get this data from teenagers in these different countries. It hovers around about 60% of them said they did want to have children at some point in the future.
But that meant 40% said they either weren’t sure or they didn’t want children. We have also been doing a project with Michael Reiss from the Institute for Education at UCL and Rina, our PhD student, and she’s been looking at men’s intentions. Men, when we asked them the age, they wanted their first child,
The actual peak was at age 35. But also many said 30. We asked them how many children, again, two to three. We asked women in a project that we’ve published a few years ago, they want children around about the age of 40. We asked them what was preventing them from having children.
Obviously things like career and finances. But actually the second most common response was I am ready to have children now. So going on to what they’ve learned in schools. Again, we’ve got lots of data from this paper, but I’m just showing you what I think is the most important graph.
This is where we had our list of topics that we feel should be taught on reproductive health in schools. The blue bar is what the kids told us they felt they learned in schools. So they learned about basically how not to get pregnant. They learned about STIs, contraception,
About puberty and about the menstrual cycle. But what was worrying was that they hadn’t learned anything about things like miscarriages, fertility, menopause. The most shocking for me were two conditions I’m going to talk about today, endometriosis and PCOS.
So we can see here, it’s just a few percent of people had learned anything about those. These are two conditions that affect one in 10 females, that is really a common disorder, and they don’t know about this. They’re not being taught about this in schools.
The orange bars were what they had learned outside school. So it’s very interesting that they had said that for some of these topics, they’ve looked for information outside. The worrying one was abortion, termination of pregnancy, but quite interestingly, a large percentage had looked for information about menopause.
Now, when I was doing these talks in schools, I use an interactive programme called Mentimeter. I asked the teenagers some information and questions as I’m going through my talk. I asked the people who are menstruating in the class, do you have any issues with your periods? Do you have pain, irregular, heavy, etc?
This was just a snapshot from one of the talks and this has not been edited. I think this is really difficult reading. Back pain, intense pain that I can’t move sometimes, painful first two days, pain to the point I used to collapse.
These are young women who are having these really adverse situations with their period and I just felt heartbroken by reading these responses. So last year, we were lucky enough to go into four schools and did eight focus groups with 15 year old girls to discuss their periods and it was really, really heartbreaking.
We’ve just submitted this paper for publication. I had some recommendations from the work that I’ve done with schools on reproductive health education. I think everyone should be taught together. Many, many teachers had told me, including the girls, that they were often separated, especially for the period talk.
I don’t think there should be one period talk at high school. I think it needs to be something that’s discussed every year. They were very, very adamant that the boys need to know about this. Separating them gave stigma to this important topic. We need the boys to be able to support the girls
And understand what they’re going through. Everything we teach about reproductive health needs to be taught together. I don’t think it should be taught by their form tutor. So in the UK, unfortunately, a lot of schools use their form tutors to give these PSHE lessons.
One of the first conversations I had was with a friend of mine, who’s a male Spanish teacher in his 50s. And he said, Joyce, the last thing I want to do is to be talking to girls about their periods. That’s really what we got from the students.
They knew that their teachers were out of their comfort zone. They weren’t biology teachers, they weren’t science teachers. They could have been a teacher of any topic. This was really not something that teachers felt comfortable with. So those conversations with the class were not really informative.
I think we shouldn’t get outside people to teach all of this. There’s a lot of groups that schools can pay to have come into the schools to give talks. But I think the teachers need to use the words. I think the teachers need to be there to support the students.
Our research has shown that the girls felt that the teachers were not someone they could approach to talk about their periods. They have to be able to do that. They also said the teachers need to, in their training, to be taught how to support girls having periods
Or issues with anything to do with reproductive health. Unfortunately, also, the toilets in schools are not fit for purpose. Nevermind about having period products, very few had free period products. But they’re also not a good place for someone who’s experiencing a period. Often, the girls said, they’re not allowed to leave the lessons,
If they feel they’ve started their period or need to change their period product. I think we need specialist teachers in schools, and we need to support and teach reproductive health. So for the menopause now, I’ve been doing a lot of menopause work over about the last eight years.
I surveyed, I think around 7,000 – 8000 women on different surveys to ask them how they feel, to listen to them about their menopause. I’m not going to go through all of these research topics today. The survey specifically aimed at black women is just being analysed now.
We even have one on cold water swimming. We have a paper that we did with younger women, asking them how they felt about it. I’ll show you a bit of the data. One of the questions we’ve asked women, is under the age of 40.
So the first bar is for the women who are under 40. The second graph is for those who are over 40 in our surveys. This again, makes very sad reading for me. We said how informed about the menopause did you feel before the age of 40.
I do not want to see not informed at all or some knowledge. Those were the biggest choices by far. I want every woman to be very informed about the menopause before the age of 40. I’m going to show you how we’re trying to tackle that. So we also asked them about their symptoms.
We gave them a very long list of potential symptoms. That’s another discussion about what are menopausal symptoms. But don’t worry about the graph. Look at the comments below. The most common symptoms they said were irritability, poor concentration, poor memory, brain fog, low mood, you can continue to read the rest.
Most people if they think about menopause, they think about hot flushes, when, in fact the most common reasons the women told us was psychological issues. That really needs to be addressed. We asked them to tell us more about how they feel about the menopause. They said there was a big lack of education.
They had no idea about the symptoms. They had problems with their GPs. Some GPs were very unsupportive and if the women weren’t over 50 they said, Oh, you’re too young. You’re not at the menopause yet. They didn’t understand that the perimenopause can start at any time.
So we need to have support from GPs. But I don’t expect the GPs to spend their precious time educating the women about the basics of the menopause. This is just one of the quotes. We have a huge number of amazingly powerful quotes from the women from the surveys.
This one said, the lack of information is shocking. I didn’t know the symptoms, so didn’t join the dots until I spoke to a friend. We are both nurses, and we didn’t know. That, I think, sums it up brilliantly. We’re not joining the dots.
Now, in the UK, we have a very negative narrative around menopause. Yesterday, some papers came out in the journal The Lancet. I’m supportive of these papers, but there have been huge responses on social media, with health professionals and influencers etc., saying that they were very shocked by these papers.
So we’ve got such a complicated narrative going on, especially in the UK, where some people are describing the menopause as a disorder and suggesting that the only way you’re going to get through this and not drop down dead is by taking hormone therapy. We’ve got this complex view.
I want to talk to you about something very positive. I talk about life post menopause as freedom, whether you’re on hormone therapy, which I’m very, very supportive of, or whether you choose not to take it or you can’t take it. I mentioned I’m a cold water swimmer.
This is us one sunrise on the Essex coast. This is how I feel life should be post menopause for women. It’s calm, it’s a new era of our lives. We’ve been governed by our menstrual cycle since we were in puberty,
And those hormones, they are doing a beautiful dance as my friend Nicky Kay would say, every month oscillating around our body, but they are powerful, and they can affect us, physically and psychologically. We’re now free of our cycling hormones. We’re free from our menstrual cycle, from periods, from premenstrual syndrome,
And the need for contraception. I’m preparing a book at the moment, I’m just doing the research called Good Health and Happiness over 50. I really want to let everyone know, but especially the younger generations, that we don’t need to be fearful of the menopause, even though it gets so much bad press.
Negativity and bad press, people love it. They love a headline that says something terrible has happened. It’s exactly the same with menopause. We seem to be thriving off these negative headlines. We don’t want to hear about anything good. There are good things.
It’s a difficult transition for many women, I don’t want to undermine that. But it really can be a brilliant phase of women’s lives where they’re very, very motivated. I really feel I’m doing the best research I’ve ever done, since I’ve been post-menopausal.
What we are doing is we are developing a UK menopause Education Support Programme. These are photos from our event yesterday talking about our programme. It’s an inclusive programme, which is being co-designed with the public. So that’s a difficult thing to do. But this is our team on the left, who I’m working with.
The picture of lots of people is from a workshop we had last October. We had a wonderful panel discussion here yesterday. So we’re doing lots of wonderful work around this. So please follow us and keep up with what we are doing. So the international reproductive health education collaboration
That I talked about at the beginning, we are trying to develop resources on all aspects of reproductive health, so from puberty to menopause. We want to be a central place where people, anyone, teachers, health professionals, but most importantly, the public, can get information about their reproductive health.
So we’ve only been going for five years, which is relatively young. So we need a bit longer. I’ll show you some of the things we’ve done already. We developed a fertility poster in 2019. We have now just updated it.
There’s going to be a big launch of this. I think at the end of March or in April. The new fertility poster, which we’ve now worked with some of the public to get their input around what we should be saying in the poster. We have videos on our website already now
About personal stories, where people have shared their experiences with various topics, including for example, endometriosis. We’ve been co-designing information leaflets for the public Here’s just three of them. We again are going to launch the first eight, maybe the first 12, in again March or April time. We have also been looking at femtech.
These are my papers looking at femtech. But the international group have also been seeing how we can use social media to promote education. My biggest happiness, I think, because this is taking me back to the beginning where I went into schools, we have developed a teacher’s resource,
Where teachers can pull out information about all of these topics to use in their classrooms. We’re going to be doing a big study, looking at how teachers around the world are using this. What I’m going to do in the last 20 minutes, is give you a whistlestop tour
Of what I think everyone should know. I think we need to start with anatomy. If we’d been doing this live, I would have got you all to stand up now and shout out vulva. So if you’re standing at home, maybe if you’re in a public place, get up and shout out vulva.
Vulva is a wonderful word. It’s interesting that we use the word penis, but we’ve got this phobia about the word vulva. So we need to understand anatomy for the male and female. We need to understand the menstrual cycle. If someone’s trying to get pregnant or not get pregnant,
I think everyone should understand the menstrual cycle. We have normally been taught in schools, we saw from the school data, they have been taught about the menstrual cycle, But I’ve got three teenagers so I’ve looked at what they’ve been taught. They’re taught that a woman has a 28 day cycle,
And they ovulate on day 14. That data is very out of date. So a project we did quite a few years ago now, I went to one of the apps that measures ovulation and cycle date. We looked at over 600,000 menstrual cycles.
We found that only 13% of women have a 28 day cycle. We need to give everyone in schools that correct information. And most importantly, we found that even though these pictures will say ovulation is on day 14, we found that it was most likely on a roughly 28 day cycle
That women would ovulate around day 15 or 16. And other big data studies have shown the same. But we need to tell everyone about these wonderful hormones that oscillate through a woman’s reproductive menstrual cycle. Oestrogen, progesterone luteinizing hormone and follicle stimulating hormone. They’re really key.
But then what’s really important is we need to teach what’s not normal. So what’s normal, but what’s not normal. And schools, nowadays language is so complicated. They’re very reluctant to talk about what’s not normal. They don’t want to stigmatise anyone who doesn’t fit in a normal range. But I think that’s a problem.
I think not teaching about a normal menstrual cycle, anything from 21 days to 35 days is considered normal. But we need to let them know that if they’re having a period outside that, then they may want to get that checked. My advice is always go to the doctor.
Don’t try direct to consumer tests or anything like that. Go and see your doctor, if you have any concerns. Tomorrow I have a podcast coming out on International Women’s Day with Dr. Philipa Kay and she’s a GP. She said that when something’s bothering you, you should go to your GP and bother them,
Because that’s their job. So if it’s affecting your lifestyle, if you have any concerns, people should absolutely go and see their GP. They need to absolutely know about endometriosis. So endometriosis, as I said earlier, it’s one in 10 women, and it’s where the tissue from the womb has left the womb
And is deposited on other parts of the organs of the body. What happens is that during the period, they will bleed and they’ll bleed into the abdominal cavity and it can cause immense pain. Girls need to know what’s normal pain for period pain and what is really affecting their lives
And should they go and get checked. I fear that too many are suffering in silence. Then we’ve got polycystic ovary syndrome. Again, one in 10 women experience polycystic ovary syndrome. Often the symptoms are that they either have no period or periods that are very irregular.
But there are lots of other issues that can happen such as acne, mood swings, reduced fertility, excess hair growth, problems with weight. So if they’re affecting anybody or you feel that this could be you, again, they should go and see their doctor.
I think it’s essential to get this information out to women as soon as possible. Now let’s have a little look at fertility. So obviously, to make a baby, I think you probably all know we need an egg, we need sperm and we need a womb.
What many people don’t know is that women have about 500 menstrual cycles in their life, and they normally only ovulate one egg. So that’s about 500 eggs a woman will ovulate every month and ovulation is where the egg is released and can then become fertilised to make an embryo and then a baby.
But men have about 100 million sperm, every single time they ejaculate. Now, some will have less and some will have more. That’s an average, 100 million sperm. So that’s a huge… Our first gender inequality starts right at reproduction. I think it’s really important for everybody to understand the fertile window,
Because we are normally taught at schools, how not to get pregnant. So what they often say to schoolchildren, and we’ve got data on this, is that you can get pregnant at any time of your menstrual cycle. But what happens is that when you’re then trying to get pregnant,
You can have this misinformation and may be not having intercourse at the right time. So actually, the fertile window is something that’s only open for six days of the menstrual cycle. Pregnancy is most likely to happen from around five days before ovulation.
So when that egg is released from the ovary, and then the day of ovulation. That’s because once the eggs released, it’s only viable for about 24 hours. The reason why it’s five days before ovulation is that sperm can exist in the female genital tract for up to five days.
When I’m in my classrooms. I normally put that out and say why is it five days before and so far someone in every class has said the right answer. So I’m really pleased that they do actually know that. Now, when you’re measuring,
If you want to measure ovulation and find out when when you are ovulating, there’s three main ways to do this. You can check your basal body temperature, which is shown in this graph here and the day you ovulate your temperature goes slightly up, which is being shown here.
You can check your cervical mucus, which is a little bit tricky, and you really need some training. Or you can check luteinizing hormone, one of those menstrual cycle hormones that peaks around 40 hours before you ovulate. So if you do a test, you just urinate on this stick,
It will tell you what day of your cycle that surge has happened. Then because the surge could have happened hours before you test it, we normally say it’s about 24 to 40 hours after that, that you could be ovulating. So I think that’s really important for people to understand
Whether they’re trying to get pregnant or not. This is the depressing slide. I think it’s it’s hard information that people I think are most in denial about. We do feel a lot younger than we ever did before. I’m in my 60s, I still think I’m 18.
We say 5 is the new 30 etc, etc. But our ovaries and our reproductive system does not feel like that. So unfortunately, female fertility is highest before the age of 35. If you look at data from fertility clinics, they will always present data for the under 35s together
Because there’s not much difference between a 34 year old and then a 28 year old. But after the age of 35, fertility decreases very rapidly. This is a graph here on the left from my book showing with age along the bottom how fertility declines, and the chance of miscarriage goes up.
That’s because of the quantity and quality of the eggs in the woman. Females are born with all the eggs we’re going to have. We have about one to 2 million at birth, potential eggs at birth. By puberty, we’ve lost most of those, we’re down to about 200 to 400,000 potential eggs left
And the others have been reabsorbed by the body. From puberty we ovulate one egg, but we lose up to about 1000 eggs each month. You can do the maths there and you can see that that’s what happens to those two to 400,000 eggs from puberty and by menopause they have all gone.
And the quality of the eggs unfortunately also declines as we move away from puberty towards menopause. The eggs have chromosomes which we inherit from mum and dad. The chromosomes from the mum are in a very delicate state, and they become more confused and muddled, the nearer you get to the menopause.
So this increases this risk of miscarriage. We can see it increases the risk of a chromosomally abnormal child, and decreases the chance of pregnancy. But it’s not all about the woman. So a woman, when she gets close to the menopause will become infertile and post-menopause she won’t be able to have children anymore.
But men also produce sperm throughout their lives. They can get someone pregnant, again, if I’m in schools, I say to shout out someone they know, a man who’s fathered children later in life, they normally say Boris Johnson. But if you’re of a certain age, there’s a lot of actors and rockstars and things
Like Mick Jagger and Rod Stewart, who have fathered children much later in their lives. But sperm quality does decrease with age. So for males over 40, they have fewer healthy sperm, there’s an increased risk of miscarriage and it takes longer to get their partner pregnant. Their health such as smoking, and their weight
Can have an effect on the health of their fertility and also the child that they will help create. So it’s difficult for everyone. We have to know about fertility decline. It’s important to know about different ways of having a family. For single people or LGBT couples, they certainly can have a family.
If they’re using donor eggs, they can use donor eggs, donor sperm and a surrogate. If they’re using donor eggs, they will have to go to a fertility clinic. But sperm can be obtained in a variety of ways without a clinic.
Surrogacy may be needed if they were a single man or same sex male couple. But there are regulations and complications about this in different countries. I think it’s really important for people who do not identify as their sex at birth to understand their reproductive options.
I’ve been thanked by some pupils in schools for sharing this with them. They said they didn’t know, and they said they felt really empowered that they had this information. So we can freeze eggs, and we can freeze sperm. This is really important because if they surgically or hormonally transition,
They will lose their fertility. There’s a little note here that we share, these are all from the school pack that we’re giving to teachers. The use of testosterone is really important to explain. Finally, the menopause. We think this is really important to educate everyone in school about menopause.
They are surrounded by women going through the menopause. They need to understand it. And they also need to understand it for when they get there. I won’t go through all of this on the slides, but we explain what the menopause is. Again, this is just some of the slides.
There’s many, many more in the teachers educational resource that we’ve made. We also included about the possible male version, the andropause, and about decreasing testosterone. I think this is the most important slide in our teachers pack and important slide for you all today is about optimising your reproductive health.
We want to prevent infertility. We want this education to prevent those needing to go to a fertility clinic. I know about this because I went through seven years of fertility treatment to have my three children. I don’t want anyone to have to go through it, it was very, very difficult.
So nutrition, exercise, sleep, our mental health and our community and friendships are absolutely key to our health, including our reproductive health. It can help with period issues, when trying to get pregnant, menopause and much more. So we want to encourage everybody to look after their health through their whole life,
Not just highlight it when they’re trying to get pregnant, or going through the menopause. We think it’s really, really important. We had a lot of press interest to our paper we published a few weeks ago about cold water swimming. We did the first research that’s been done in the world
About menstrual and menopause symptoms, and how cold water swimming can help this. We did a great event this week at UCL for International Women’s Day about exercise and women’s health. So my bit of advice to everybody is especially if we’re working at home too long and just sitting all day long,
We should all be moving all through the day. We need to get out into the blue and green of our wonderful planet. We need to ideally be exercising, increasing our heart rate and if we can do this with friends, it’s just a win win situation. For those that cold water swim,
That added cherry on the cake is the coldness of the water. Many women reported to us so that they felt it really helped them. But I don’t expect everybody to start jumping in a cold piece of water. It does have have risks to it. So I’ve gone through a lot today.
I hope that it’s been useful to some of you. I want to educate everyone about their reproductive health. I want to radically change education in the UK and globally. I think social media is a great thing. But some people shout very loudly with misinformation, so we need to ensure we’ve got reliable sources.
And femtech is a great thing. We had a great discussion about it yesterday at the RCOG. Today, we’ve already been discussing femtech in health check. Adam Balen asked the panel about regulation, because this is something that’s poorly regulated.
I asked them about the worry of a lot of femtech I’m seeing that’s got no evidence for it. Femech encapsulates any tech that’s dealing with women’s health, so it doesn’t need to be digital tech. It can be supplements, powders, lotions, face creams, everything.
My Twitter feed and Facebook feed every day is full of these incredible marketing campaigns, saying that this particular supplement is going to help you lose weight, it’s going to get rid of all your menopause symptoms, you’re going to feel fabulous, you’re going to look younger, all these are, it’s unbelievable what they say
That taking a mixture of vitamins and minerals is going to do, and there’s no evidence for this. It’s fabulous marketing. But I really feel strongly we need to empower everybody with the correct information and not misinformation. I’d just like to acknowledge all my lovely team at UCL and beyond.
This is the International Committee. We have a meeting in Brussels on Monday I’m looking forward to and we can take some more photos. This is how to contact me. I’m on all social media as Prof. Joyce Harper. I hope you can do this via YouTube, but we have a menopause project we’re doing.
We have a survey that’s live for a few more weeks, where we’re asking women and those who are born female, if they can tell us what they want, how would they want this programme to look? What do they want to know about menopause?
So there’s a QR code here on the top left, that you can use to take the survey. If you have any problems with that get in contact, and we’ll send you the link. So I will finish there. Thank you so much. It was very hard doing this without interacting so well.
But hopefully you’ve put lots of questions on the Slido. Thank you very much, Joyce. Let’s go to the Slido and look at some of the questions. So there’s been a very big response to your questions, Joyce, with people sending information about how little or how they were taught about reproductive health in schools.
There is a fairly universal opinion that there’s need for improvement on it looking at these remarks. I’m just hopefully going to pick up some of the questions. Maybe Kate can help with that. So I’ve seen there’s a few there telling us about teaching reproductive health at school and how it must improve.
When I went into schools, I was disappointed that it hasn’t moved on a lot. I’ve got three sons. I’ve talked to my sons a lot about the health education that they’ve received and hearing from the girls telling us that… The girls I spoke to were age 15. What schools do,
They do one talk on periods in year seven. They do one before that one at primary when they’re about seven years old. Then when they get to high school in year seven, they do another one, so they’re about 11 years old. These girls were in year seven in lockdown.
So they got to high school and immediately went home and went to lockdown. Some of them told me that that talk never happened. When I said to the teachers did you teach them about their periods during lockdown? The said, we think we did. But the girls told me they didn’t.
But anyway, it shouldn’t be one talk. It really shouldn’t be one talk about having periods. So anyone, ifou’d like to put any questions or comments on Slido, specifically about periods, but yeah, we really need to change this. I’d also like to hear your views.
You can put comments on Slido about separating boys and girls. I think girls would like to have follow up support and maybe some discussion groups with their teachers. But they felt very strongly that the main lesson should be all together, and that the boys should should be taught about it.
Could I come in then now Joyce with a question related to inclusivity like that? One question is, have you noticed drastic differences in reproductive health according to race, e.g. black, white, Hispanic or Asian? Yes. Hopefully, people are aware that we have big disparities in just reproductive health.
So unfortunately, Black and Asian women in the UK have a lot worse outcomes for many, many issues. Maternal mortality is higher in these populations. And their time for diagnosis of different disorders is higher, much longer. There are huge differences. We need to solve those.
One of the problems I found with my own research was that the surveys I put out, I’ve done many surveys, they’re all mainly completed, not totally, but mainly completed by white middle class people. So that’s why we specifically launched the survey for black menopausal women. I worked with…
Actually, a couple of women came up to me from the black community and said, please, can you do the survey just for our women. And we did that. But it was really, really hard to get them to apply. And the people I’m working with said that they were very cautious about speaking up.
So we need to really encourage that. I think in the end, I think we’re looking at 500 women, whereas in the complimentary survey we did that that anyone could answer, it was 3,500 women in a much, much shorter time. So we need to get people in that community to come on board,
To talk to us, to tell us what’s wrong. We need to improve reproductive health and reproductive health education for these groups. With our menopause study, we are doing a specific focus group, with women from different cultures to ask them what are the issues
And how can we help deliver an menopause education project to their community? So there’s lots to discuss there, for sure. Okay, thank you. We have another question, which is interesting. Why is modern science and publication starting to play down the cliff of age 35? Oh, dear, I do blame social media unfortunately.
Well, first, first of all, there are some people out there who are quite loud who say that it’s just the patriarchy trying to get women all to have children and become mothers and give up work. I wish, well, I don’t wish that was true. But it’s not true. It’s our biology.
But yeah, we are also bombarded by seeing celebrities who have children in their late 40s, early 50s. A few years ago, I just said late 40s. But now we’ve got a few celebrities who have been very, very public, and who have had a baby in their 50s,
But not being public about how that child was conceived, or how the child was delivered. So one very well known model, she said all these phrases that I’ve read that were very ambiguous. I think she had surrogacy, I think she probably had a donor embryo. But it didn’t say that anywhere.
So it gives women reading this the false information that getting pregnant and having a baby in your 40s and 50s is easy. Some of the celebrities have said this. It’s easy. You can get pregnant at any age. And that’s just not true. So if you want to see,
Because a lot of people think that IVF fertility treatment will be the answer and can get anyone pregnant. But if you want to go and look at the Human Fertilisation, and Embryology Authority data, this is the UK statutory data for the success of IVF.
You will see the chance of getting pregnant over the age of 43 by IVF, is just a few percent. It’s a lot to go through, and hugely expensive, with a very, very small chance of getting pregnant. So misinformation is the problem. I spend too much of my life trying to undo myths.
My whole book was about undoing myths, and I spend my whole time on social media. Unfortunately, you get health professionals arguing a lot. It’s really muddled and confusing to the public out there. As a broader question next, which perhaps resonates with that, what advice would you give an early career researcher
Who’s about to start a PhD in women’s health? Yes, I was one of those once. So I would never give someone specific advice. I think everyone’s individual. That’s one really key thing, actually, that I don’t think I said, because I’ve been giving so many talks this week.
And I should say, women and men, our reproduction is totally individual, both what we want to achieve, and our reproductive system. So every woman’s menstrual cycle will be different, every woman’s perimenopause will be totally different. What I would just want is that that person knows the options and knows the correct information,
So knows that fertility declines with age, and knows about how to get pregnant and understand their fertile window. Then they need to make the decision of when they would like to do that. I think one problem in in the UK at the moment
Is trying to find a partner who’s ready and willing, that was my problem. I had a long relationship, my partner wasn’t ready. Then we split up when I was 32. So I understand how difficult this is. And then the difficulty of juggling being a parent and working.
We are trying to make, certainly academia, at our institute, we’ve got a gold Athena SWAN award, to try and make sure that people are supported both at work and in their in their private lives, especially people who are carers. We hope that people will have a supportive work environment.
But besides all of that it’s very expensive. It’s really expensive for the childcare. So I just would like them to know all the information and then to make up their own mind about when and if they wanted to have children. On your kind of theme of empowering, next question is interesting,
Because of the potential of femtech to empower people. What do you think about the current research, and moreover, the potential towards digital biomarkers for menstrual health? I am a fan of tech, for sure. And I’m a fan of a lot. I’ve just heard some brilliant talks about using tech.
One of them was about pelvic pain. They’ve got an an app for women with pelvic problems. It was fabulous, absolutely fabulous. We talked a lot yesterday in our innovations discussion about period tracker apps. I think if I was still having a period, I would definitely use a period tracker app.
I would want to know when my period’s coming. I think I would use it quite thoroughly. I think I would put in about symptoms and help me understand my menstrual cycle. Those hormones that are oscillating and dancing through our menstrual cycle, they really can affect our mood, and us physically and mentally.
So I think understanding that and working with that for you, I think using an app allows you to do that for you, so that you can see okay, oh, I’m not feeling great today. Okay, actually, last month on day 28 of my cycle, I wasn’t feeling well,
So figure out and work with your menstrual cycle, and work with the app to help you understand your body and see what is affecting it. So for example, I’m very obsessed with exercise and encouraging people to to exercise. I’m an ambassador for This Girl Can,
The UK programme to try and encourage women and girls to exercise and through our menstrual cycle, we might want to do things differently. So we might want to do something really energetic in the middle of our cycle. When we’ve got our period, we might want to do something more relaxing.
But understanding that, working with your body, I think it’s really important and the apps can really help you do that. There’s another question really about awareness. How can we increase awareness of what is and isn’t normal in your 20s and 30s? Particularly regarding the effects of hormones, early signs of infertility etc.?
Obviously, what my passion is, is to get this in schools, to really get these discussions going, get the teachers to start teaching students about these and understanding what’s normal and not normal. It’s great that we’re doing this menopause project so we’ll get everyone, my vision really,
Is everyone in the UK to have taken at least one of our offerings, our resources so that they can learn about this. But we’ve got a big gap in the middle. We’ve got those people who didn’t learn about this at school, and are now probably most of the people listening to this talk.
We need to do something for them. I don’t know how many years I’ve got left to be able to work on these projects. But in Denmark in Copenhagen, some friends have set up a clinic, they’ve got funding to make a clinic for people who want to have children but not yet.
They’re teaching them all of these things. So again, they’re sort of slotting in there in the middle. We need to do much more. We need to have really good evidence-based education. As I said, social media helps but it also muddies the water.
Okay, so to wrap up, this last question is probably a good one for you because it’d be almost like your take home messages, I think. What do you think we could all do to help raise awareness and improve things for the better once and for all?
If you had to put that three things, three main things that you want to get the message across. I’m not sure they if they want to know… Read the question again, sorry. What do you think we could all do to help raise awareness and improve things for the better? Okay, to raise awareness,
I think what we need to do is follow the evidence of reproductive health. So be careful of influencers. The International Group, we will be putting out lots of resources, so follow us. Follow the British Fertility Society. Follow the American Fertility Society. They have proper information. But besides the awareness,
I think my main message of what people can do for their own reproductive health is to look after those five pillars of wellbeing, our exercise, nutrition, sleep, our mental health, and our friendships and community. That way, I feel we can all have good health and happiness at any age.
So I hope that everyone can do that. A really nice, optimistic message to end on. I want to thank the audience for their questions, in particular, of course, to Professor Harper for this brilliant talk, filled with enthusiasm and information. We’re coming to the end of this session now,
But I want to remind you that the next Lunch Hour Lecture is entitled, Dental Implants and Hollywood Smiles: Advances and Pitfalls with Professor Petridis on the 19th of March running from 1pm till 2pm. Thanks again to Joyce and to you out there in the audience who’ve participated. So this session is now over.
Thank you. Thank you.