The Dr Louise Newson Podcast - 101 - Dorothy Byrne: Speaking out about the menopause at work

Episode Date: June 1, 2021

Dorothy Byrne is the Editor at Large at Channel 4 and was Head of News and Current Affairs for 17 years at the channel. In this podcast episode, she speaks with Dr Louise Newson about her own experience of speaking up about the menopause at work. Dorothy gave a MacTaggart lecture at the TV industry's biggest event of the year, The Edinburgh Television Festival, and received an overwhelming response for talking about the menopause in such a setting.(The lecture is available to watch in full on Edinburgh Television Festival's YouTube channel).   Dorothy and Louise also discuss the debilitating effects of some of the long-term consequences of the menopause such as a lack of sleep and osteoporosis, and the challenges of getting testosterone prescribed on the NHS.   Dorothy's 3 top tips:   Go and see your doctor if you're suffering. Tell them you need to know more about your treatment options and get advice. Ask them to discuss HRT with you rather than it being quickly dismissed.   Not sleeping is a serious lifestyle and medical issue. Don't put up with it, the long-term effects on your health from a lack of sleep are considerable.   Going through the menopause and being an older woman can be great. You can be more confident, you receive less unwanted attention from men, you don't have to worry about getting pregnant, there are so many upsides. Don't accept the consequences of menopause when you can have another 20, 30, or even 40 years of a great life ahead of you.

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsome, a GP and menopause specialist, and I'm also the founder of the Menopause charity. In addition, I run the Newsome Health Menopause and Well-Being Clinic here in Stratford-upon-Avon. So today on this podcast, I'm really delighted to introduce to you Dorothy Byrne, who many of you will hopefully have heard of. She's the editor-ed at large for Channel 4. She was the head of news and current affairs for Channel 4 for 15 years. And she's also the president-elect of Murray Edwards College, which is a women's college at Cambridge. So welcome Dorothy to the pepcast. Thank you very much. It's great to be here talking to you. So we were introduced actually by Kate Muir, who many of you know I've done a podcast with her. And she was the Times film critic for many years. And she's written and and produced the most amazing documentary on Channel 4

that will have been produced by the time this podcast comes out and what it would have been available for people to watch. And Kate said to me a while ago, you really need to meet Dorothy and I'd really like you to talk to her. She doesn't really think much that she's suffering in a much way about the menopause, but she's been talking about it. And she actually spoke about it at the Muttagot Lecture in Edinburgh. And people then listened.

And I thought, actually, this is incredible. So I'll be really interested, actually, if you don't mind, talking about the lecture that you gave and your sort of thoughts about menopause before and after actually starting your own journey, if you like, onto getting some treatment. Well, it's very interesting to me that when I gave the MacTaggart lecture

at the Edinburgh TV Festival, which is the main lecture in the TV year for the television industry, I talked about so many different things about how women are assaulted at work, the state of British television. And yet the thing which seemed to get the most attention of all was that at the end I talked about the menopause. And afterwards, women even came up to me in the street and said, you talked about the menopause, you actually talked about it. And I hadn't realized until then that although the menopause might be mentioned in

women's magazines or women's pages in newspapers, it's actually not talked about in general life and in particular what people have said to me is that successful women don't talk about the menopause. It's as if the menopause is just a secret problem for a few women and it's not the case that in fact all women or I assume all women, you know, go through the menopause and have all very different experiences of it. And one of the things that actually interests me is that it's not just that some men are prejudiced about the menopause. I think some women themselves are prejudiced about the menopause. One of the things I think is quite annoying to women who do suffer problems during the menopause. And I think about,

a quarter of women suffer, you know, really quite bad problems that affect their health and their work. But there are a number of women who don't have any problems with the menopause. And they go about saying some of them, well, I didn't have any problem with the menopause. And I think, what a weird way to look at things. that would be like saying, why are you complaining that you broke your leg? I didn't break my leg. And it's the only medical subject I can think of where women show off about not having had problems and therefore make other women who have had problems feel bad about it.

And yet having problems is so widespread. that we do need to talk about it. And I feel strongly that women now talk about issues to do with childbirth, maternity, child care. So we have got a lot better at talking about the issues that affect women when they're younger, but we're still bad at talking about the key issue that affects women when they're older, which is the menopause. In the past, women didn't dare talk about it, and I can see why,

because a number of men and women were prejudiced at work about women who said they had problems, and they would make sarcastic remarks about older women and say, oh, well, you know, she's going through the change. But it's now illegal to talk in that prejudiced way. So I think that we should all talk about it. And in fact, because I talked about it, Kate said to me, oh, well, you know, what sort of issues do you have?

And I said, well, my main issue is that even now, about 10 years on, I'm still having difficulty sleeping. And I thought that if you didn't go on HRT, at the time that you were going through your main menopause, that was it. You could never go on HRT. But she explained that actually that isn't the case and that even if you're one decade on,

you can go on HRT. And so anyway, I've gone on HRT. and the key thing for me is that I had just got used to waking up at least three times every night. I just thought this is the way I have to live. I would always woke up feeling tired. But since I went on to HRT, I now sleep at night and it has completely transformed my life. I just have so much more energy. And people say I look younger,

but I think that's mainly because I slept. Not sleeping or waking up all the time. It's just so exhausting. You wake up in the morning, really worn out. And the other thing is I used to worry because I would read medical statistics. about how, if you don't sleep properly, it potentially raises your statistical risk of cancer. And everybody worries about HRT and cancer.

And yet, women should be worrying about, and they should think about all that issue, of course, and they should know all the facts. But they should also look at the facts about not sleep, and cancer and other illnesses. And certainly for me, now that I sleep, I've always been a happy person, even when exhausted, but I'm no an even happier person

because it's lovely waking up in the morning, having slept all night. It's amazing, isn't it? I hadn't realised, even as a doctor and a menopause specialist, how sleep really did become so disrupted for so many women during the perimenopause. and I know it's related to the hormones because after three, six months, like you, they come back and say, goodness, I'm sleeping better and nothing else has changed in their life other than taking

hormones. And you're absolutely right. It's not just cancer risk, of course. We know that heart disease, dementia, osteoporosis increases with poor sleep. And that is a real issue, but also women who have low hormone levels have an increased risk of heart disease, osteoporosis, dementia, some types of cancer. So when you have a real issue, but also, women who have, women who have, low hormone levels, have an increased risk of cancer. So when you have a menopausal woman with low hormone levels who doesn't sleep well, actually the health risks are really quite dangerous. And I would love to do a study to show that women who take HRT have a lower risk of cancer. The studies so far have been so poorly designed that we can't interpret anything from them. We certainly can't interpret breast cancer risk

from our current literature that we have of the types of HRT that we prescribe. The studies we do have, have shown that there isn't a statistically significant increase risk of breast cancer, and there is a reduction risk of dying from breast cancer. But I would love to show the world that actually taking HRT reduces risk of cancer because lifestyle improves, but also the direct effect of hormones. So we have to look at everything else that's happening. And you're absolutely right. A lot of people say, well, you should only take HRT or start taking HRT within 10 years

of your menopause and after that, forget it. Actually, the average age of menopause is 50, so does that mean at 60? You're just on a dust heap and just forget it. Because you're still young at 60. It's not old, is it? And I think this is such a shame. Well, I'm really 69 and I feel young.

I mean, people say you're as old as you feel. And if you don't sleep at night, you feel really old. Absolutely. I mean, I think it adds years. to your life, not sleeping. But I think it's very revealing that you're saying that these studies, really good studies, don't exist because this is half the population of the world. And there are two things that we know are true.

We're all going to die. And if we're a woman, we're all going to go through the menopause. therefore it should be massively studied. And I think that employers and Channel 4 where I work is the first major broadcaster to have a menopause policy. And part of that menopause policy is talking about the menopause and all managers being educated in issues about the menopause. but also encouraging women to talk about it between themselves.

Which is really important, but I do worry sometimes about metaphors policies, if I'm honest, though, because there's a lot of people that are giving information in the workplace, which is really important, but they're talking about it, and they're also saying where you can reduce your hours, we can change the temperature of the air conditioning, you could have flexible working. Actually, what these women need is access to proper. treatment and proper help, which is often what they're not getting. And, you know, talking about broken arm, you don't have a broken arm policy at work because you go and fix it. And we have treatment

that most women aren't able to get, which is a really, really sad state of affairs, I think. It's such a shame that people are having to adjust their work. And we know up to 20% of women give up their work because of their symptoms. And I had a patient recently who changed her job so many times. She started from a high power job. Then she went into being a receptionist, but she couldn't remember the codes just to get into a computer. So then she became a cleaner, but she had such bad muscle pain and stiffness. She had to give up job as a cleaner. And so she's got no state pension. She's got no income. And that was her life for 10 years being diagnosed as fibromyalgia. and luckily her husband was very supportive

and her mother actually gave us some money to come for a consultation here and within three months she's saying gosh, I had no idea I definitely didn't have phobomyelia and I'm really now thinking about how can I get a job as a 52 year old woman and that's awful actually

that people should have to change their jobs because of the menopause. It shouldn't happen. Why would you do that? Well I feel that a menopause policy should include in a company of any size, bringing in experts to talk to women and men about the facts of the menopause and about the things that you can do. And it may well be that some women decide, I don't want to be on HRT, and I'll put up with the symptoms, etc. But really, that should be up to them. you know, they should have that alternative offered to them,

as well as other information being given to them about, you know, if you don't want to suffer symptoms of the menopause, drinking less alcohol, eating differently. You know, there are other things as well. Absolutely. And there are those things, they're important anyway, whether you take HRT or not, is really important. and it is so important that we are all given the right information that's pertinent to us and our own situation.

And also I think it's really important that people know as women that any decision we make is not irreversible. So if someone decides, for example, they don't want to take HRT but they want more information and then decide they might want to try it because of the health benefits, then that's fine. And also, like you were saying, for women who have gone many years after, their last period without HRT, they can still start it if they want to. No one's too old to start because there are benefits certainly for bone and heart and probably for dementia protection as well from starting HRT at any age. So I think it's very important because I think women feel very vulnerable at this time or a lot of women do at this time of our lives. And some people say,

well, if you've got her work policy, do women really want to have a badge saying I'm menopause along? And I don't think most of us do, but actually we want to feel that people are looking out for us and that we can have a conversation if we're having a difficult day or someone actually might pick up. I wish someone in my workplace five years ago said to me, Louise, you've really changed, actually. You look really tired and you're not working quite as fast as you were. Is everything all right? Have you read anything about menopause? And I wish someone had told me, because I had six months of being very close to giving up being a doctor.

and my menopause specialist as well I didn't even think about my own hormones so if someone at work had had and this is me as a GP if someone at work could have a menopause policy and one of the receptionists who I knew very well and I was working there had read or been taught something

she could have really saved me a lot of stress actually worrying about my future career but I think women even more than men are brought up to think that they just have to put up with things. And so often you'll hear women say maybe they get paid less than a man or they feel really tired

or their bosses bullying them. And we've learned as women that we mustn't put up with a lot of these things. So we've learned equal pay is the law. go to court. You know, when I was young, women had to put up with being sexually harassed by men at work. We've learned, you don't have to move up with that anymore. When I was much, much younger, of course, women who were bitten by their husbands were told by their mothers and fathers sometimes, well, you can't leave your husband, you can't leave your children. So, We've learned not to put up with other things.

And I think we need to learn, not just to put up with all the problems and issues of the menopause, whatever you decide to do as a woman, that's your decision. But you should have the right to really good information on which to make your decision. And you shouldn't just have to put up with being. miserable and not tell people. I'm quite shocked by the number of women who if they felt ill wouldn't come into work, but if they feel ill and exhausted because of the menopause, they think, oh, well, I still need to struggle into work. And if you feel ill for any reason, you feel ill and you know you shouldn't have to come into work but it does raise the question of

if you feel ill actually ill then you know you should be able to go to a doctor and say i don't feel well what are the other options for me yeah on bbc i player i watched a great film french film i don't know if you've seen it i've got life and it's about an older woman who thinks she's all washed up and unattractive and she's going through the menopause and she goes to her GP and she says to him at the beginning of the film

any chance that I could be on HRT and he just goes, no, no none at all and because she's saying I sweat all the time I'm exhausted and he just dismisses her completely and it's all tied up with her feeling she's no longer an attractive woman and actually it's a lovely film because in the end she falls in love just to give the plot to work oh no but actually the way that doctor just dismisses her at the beginning i think is really shocking and i actually think

doctors should be suggesting to women, should you be on HRT if women are going to the doctor and saying, I'm absolutely worn out? Doctors should be discussing with women that option rather than either not mentioning HRT or just saying, well, you should only go on HRT if you're really wrong. I mean, I don't know how ill really, really ill has to be for a lot of GPs to think, now you're ill enough to go on HRT. Well, we wouldn't say that about other subjects to do with the human body. You're absolutely right. And I certainly the work that we're doing with the Menopause charity that I've recently founded is really trying to address this whole inequality, but also about let women have HRT.

Those women who want it, let them have it. And it really should be for free because all other hormones on the NHS in the UK are free. So if I had an underactive fibrogy gland, I would feel tired, I would put on weight, I would feel miserable. I could probably work, but not very well. But I would go and get thyroxin. And then I would have free prescriptions, not just for the thyroxin, but for everything else as well. That's the NHS policy. If I was diabetic and I had my pancreas networking when I had diabetes, I would get insulin on the NHS and everything else.

as well. If I have my ovaries removed and I was clearly became menopausal, then a lot of people don't even give replacement HRT. And some people come and see this in the clinic and their, their surgeons say, I'm removing your ovaries, but just see how you get on with it. You don't need HRT, unless you're really bad, come back. Well, why would you do that? Why would you remove an organ, especially in a young person and not do it? So I've got a 23-year-old patient at the moment who's had an early menopause and she can't get HRT. She's in a same-sex relationship and the first doctor she saw said, well, you'll be infertile, but don't worry, there's two wounds in your relationship and HRT is too dangerous. And that's, you know, how can you talk to people like that?

How can you deny evidence-based treatment? So there's a huge, huge amount of education work that needs doing. And I think it is about being non-judgmental. As a doctor, we are, I really strongly feel I'm here to be an advocate for patient. I'm not here to tell a woman or a man or a child as my patient what they can and can't do or what they should or shouldn't do. I'm just here to advise on best practice and then it's up to them to decide. You know, I could tell you, well, actually, Dorothy, it's really not a good idea to eat McDonald's three males every single day. If you choose that, that's absolutely fine. I'm not going to judge you for it. And that's the same with anything else, but I don't know why it's happened that, like you say, it's almost like a failure to

take it. And where I used to work as a GP, they are now refusing to prescribe HRT for any of my patients. I worked there for 15 years and a lot of my patients were taking HRT and now they can't get it because they're being refused. And then we've got the whole testosterone discussion where it's not even licensed for women. It's a hormone that we produce in higher quantities than estrogen, yet we're not allowed it back with our own healthcare system unless we buy it privately, or we get the male testosterone through the NHS if we're really lucky because our GP prescribes it for us. What's that about? That's just cruel, isn't it? Why is it that the NHS won't provide testosterone, which, you know, my GP has said that the NHS will pay for my hormone treatment,

but not for the testosterone. What is the issue that the NHS has with it? Well, it's because it's not licensed, but actually we prescribe a lot of things off licence. So say, for example, you had a nerve type pain, you had a trap nerve in your neck and you had nerve pain going down your arm. We often give something like amyptylene,

which is also an antidepressant. In a low dose, it really helps with nerve pain. It's not licensed to be used for nerve pain, but we know it's safe, it's effective, so we use it. A lot of drugs we use for children, for example, don't have a licence, but we know it's safe, and so we give it. So about 20% of things we prescribe actually are off licence. Now, testosterone used to be in a patch, and it was licensed for women, but then the drug company stopped making the patch. So they decided to just withdraw the licence, and I've got no idea why.

But we know for years that testosterone is safe, it's effective, it's just replacing the hormone that your body would be. producing and certainly in young women who are designed to have testosterone, when you suddenly remove it when they're young, it really affects not just their libido, but their mood, their concentration, their stamina, their energy, often their sleep. And also we know that having testosterone can improve bone density, so it's more likely to, well, women's less likely to develop osteoporosis. And so there's benefits, but because we haven't had a product, no one's interested and no one has taken it forward. And there is now this testosterone cream that has become licensed in Australia.

And we're hoping that the MHRA will look at the application again to see if we can get it licensed over here. But when the first meeting they had, one of the doctors there was saying, well, it's a cream. What happens if it goes on to the female's partner's leg and gets rubbed on? Well, men have testosterone, actually. and then she said, well, what about if a woman becomes pregnant on testosterone? Well, women have testosterone.

It's a natural hormone. So there's very little reason not to have it. And my concern is that women will get hold of it anyway. I have a lot of women who I speak to who have pretended actually to be their male partners and bought it online through various pharmacies. But they don't know how to use it. They're not monitoring it properly. So it's really difficult, actually.

And I do often think if I was a drug addict trying to come off heroin, it would be a lot easier to get methadone from my GP. It would be a lot easier to get support. But actually, you know, having HRT is a lot safer than having methadone. It just doesn't seem right. And as you say, it's not an obscure condition that, you know, if I didn't know something about the brand new drug that had come out with a very obscure cancer, for example, Well, I might be forgiven as a GP to not know that.

But actually, why? You can't forgive me for not knowing anything about the menopause, when it affects all-female adults. The other thing I feel very strongly about because osteoporosis is a big issue in my family. Both my mother and my grandmother ended their lives as those bent over old women who can't look ahead properly is that osteoporosis is not treated as if it's a potentially life-threatening and life-reducing illness.

So people talk about cancer. Osteoporosis is treated as, well, it just means your bones get a bit thin, so you need to be careful. But when you look at the statistics for what happens to elderly women, with osteoporosis when they fall over and break their hip. The statistics of the percentage of them who are dead in a pretty short period of time, really quite quite a minute. It's about 25% will die in the first six months. It's quite horrendous.

And it's costly. Osteopotic hip fractures cost the NHS $3 billion a year. You know, that's a huge amount of money. So one of the treatments for osteoporosis, a licensed treatment for osteoporosis is HRT. Yet, when I speak to many osteoporosis consultants and specialists, they don't know how to prescribe HRT and they think it's too dangerous to prescribe. But actually, it's very cheap, it's very effective. HRT not only reduces risk of osteoporosis and strengthens bones, but it also has other health benefits, as we know.

So that needs to change quite urgently, I think. Well, I feel in general that the attitude towards osteoporosis and older women is very poor and that this is a group of women who are neglected. I think a lot of women are taking by phosphonates that they find very uncomfortable to take. and there are alternative ways in which you can take it that are less uncomfortable, but women are just expected to put up with taking drugs for osteoporosis in a way that isn't comfortable for them. Similarly, the calcium tablets, a lot of women, I found I couldn't take calcium tablets. It caused me great pain.

and yet we're just meant to put up with it all. Yes, and I think the compliance for the drugs such as bisphosphonates because they can irritate the gullet, you have to be sitting up, you have to not eat for a certain length of time, and the compliance is really low. So I've had so many patients where I've done home visits on and I open their cupboard to see what drugs they're on, and they've got the cupboards full of this stuff

because they never take it because they don't like it. Well, my mother, when she was very old, when they gave her the calcium tablet, she found them so horrible to take that when you went to visit her, if you looked under the chair she generally sat in, there was a pile of calcium tablets under it. And, you know, when I look at how awful my grandmother's life was when she was older and my mother's life, I am grateful that I'm able to take HRT so that I don't,

end up, I hope, as a bent over old lady who can't even look ahead. My grandmother couldn't look directly in front of her. She was so bent over. And my mother had one of those necks that turned into a curve. And it made these older women so nervous about going out and doing anything because they feel so frail and fragile. And that is very ageing in itself. It totally is. Fools are such a huge thing. And there's a big anti-Falls policy. The Royal College of Physicians have written a whole lot about risk assessment of falls. Not once is mentioned about hormones or menopause. And it's so important. My mother, she missed her footing last week on the stairs. she was carrying a glass of water going up the stairs

and she missed her footing and I heard this thud and I heard a glass and I thought oh gone it, goodness mainly ran to her she's lying on the floor and thinking oh no, she's definitely broken something. Anyway, she laughs, gets up and carries on going upstairs to bed but she's on HRT. There is absolutely, I can guarantee

the time before she had in her age she would have definitely had an osteoprotic fracture. But you don't know you've got osteoporocic fracture often and then it's too late. Well, I think that just as I feel the menopause should be discussed at work and the facts about HRT should be discussed at work, I think osteoporosis should be discussed at work. Absolutely.

Because that's a high percentage of women are going to have that problem when they're older. And it all really needs to be talked about and not just talked about occasionally on the women's page of a magazine. I totally agree. We've got a dexter bone density scan in our clinic and I really strongly feel that everyone should know what their bone density. Men and women, once they reach middle age, they should know what their bone density is because it's not just HRT. Of course, it's looking at our lifestyle. It's looking at exercise. It's looking at calcium in our diet. But it's essential because it's so important that we look after our bones. And certainly the main reason I take HRT is to protect our bones. It really is. So there's lots that needs to be done. And I think, you know, absolutely right. Menopause, osteoporosis should be up there. We should be talking about it.

We should really help as many women as possible. And indirectly, that will help men. So everyone wins, actually. So I'm really grateful, Dorothy, for your time today. It's been really enlightening. And so I always have three take-home tips that I ask my guests to help to share to the audience. So I'd be really grateful, actually. could give three tips to women who are slightly older, who have gone through their menopause,

maybe one, two, three decades in the past. What would you suggest for them to do to try and get help? I think that women who feel they are suffering should go to their doctor and say, you're a doctor. Your job is to help people who are suffering and I'm suffering. And if I was suffering with any other issue, you would help me. So I expect you. It's your job to offer me help and advice and to at least discuss with me HRT. There might be a reason a woman can't take HRT. There might be a reason a woman doesn't fancy taking HRT.

but it should be an option that can be discussed for any woman so that it is at least considered and she at least gets that basic advice because nobody should have to put up with pain and suffering if it's not necessary. There is pain and suffering that's necessary. We can't get round it, But if it's not necessary, we shouldn't have to put up with it. I particularly feel that not sleeping is a serious issue. It's a serious lifestyle issue and it's a serious medical issue. And that women who cannot sleep should feel empowered to go to the doctor and say, I'm not sleeping and it's really causing me a lot of problems.

And the final thing I would say is that going through the menopause and being an older woman is great in many ways. You know, you've lived your whole life terrified of getting pregnant. At last, you don't have to be worried about getting pregnant. often you're a lot more confident when you're an older woman and you're harass less. You know, there are so many upsides to being an older woman and you don't just have to think, well, now I'm an older woman, I won't be able to sleep, I'll feel exhausted all the time, I'll have thin bones and then I'll die.

You know, you're going to have 20, 30, even 40 years of great life. Brilliant. That is such a great way to end because I'd strongly feel that menopause should be a really positive experience for all of us. And you're a great inspiration. So thanks ever so much, Dorothy. I really appreciate it. Well, thank you very much. For more information about the perimenopause and menopause,

You can go to my website, menopausedoctor.com.uk. Or you can download our free app called Balance, available through the App Store and Google Play.