The Dr Louise Newson Podcast - 205 - Author Joanne Harris: ending the invisibility of menopausal women

Episode Date: May 23, 2023

Bestselling author of Chocolat Joanne Harris joins Dr Louise Newson to talk about her latest book, Broken Light. Broken Light’s protagonist is Bernie, a 49-year-old who has given her life to her family and friends, and feels invisible. But Bernie finds her supernatural powers as she reaches the menopause, which becomes a metaphor for the anger of women in later life who are too often silenced in art and reality. In this episode, Joanne talks about her own menopause experience, and her and Dr Louise discuss their work in ensuring the voices of women are heard as they get older – and the progress that still needs to be made. Joanne’s four reasons to read her new novel:  Menopause is a universal experience that needs to be understood. The way women feel shapes our world and shouldn’t be ignored Because if you are a woman you will experience the menopause If you are man, menopause will also be part of your experience at some point, and you need to be informed Because it is a fun read! Click here to find out more about Joanne Harris, and follow her on Twitter at @Joannechocolat    

Hello, I'm Dr Louise Newsome and welcome to my podcast. I'm a GP and menopause specialist and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-Bron-Avon. I'm also the founder of the Menopause charity and the menopause support app called Balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based, information and advice about both the perimenopause and the menopause. Today on the podcast, I've got someone who actually I've respected for many years since I read a novel that she wrote called Chocolate a long time ago. And it really resonated with me,

a very powerful, beautiful actual novel. So the author Joanne Harris is now in front of me. So I'm a fangirling her, actually, but she doesn't realize. So thanks ever so much for coming to talk today, Joanne. It's a pleasure to be here. Thank you. So your publisher's got in touch with me, and you've written this book, which is now out called Broken Light. Amazing book. I finished it last night, actually, and I used to read a lot, but now all I seem to do is work and don't have as much time to read, which is one of my biggest regrets. So actually, I had to read this book and I had to finish it by today. And it was great because last night I sat on the sofa and I was just in my own world. And how wonderful was that? So I'm very grateful that you've given me some time to rekindle. my joy of reading. So tell me about the book.

It's a book about growing older and feeling invisible and women's rage, actually. It's a bit of a metaphor. And there is a nod in there to Stephen King's Carrie, because Carrie, of course, achieves her supernatural awakening at puberty. And my heroine, Bernie Moon, finds her supernatural powers at menopause instead. And so the whole thing is a kind of metaphor for menopause and anger and women in later life who don't normally get to be the protagonists of novels that often. It's very unusual to read a book where you've got Bernie's experience weaved throughout so many pages. Sometimes menopause is mentioned in a odd little few sentences or a few pages in a book, but it's quite unusual, isn't it, to have a book where you can really get a sense of the

suffering and the emotions as well. So the psychological symptoms that are going on, not just the physical symptoms. Yes, I wanted to do that because it's actually, it's a topic that needs to be demystified. And it's really not mentioned very often in fiction. It tends to be thought of as just a bit disgusting and not something that people want to read about. Turns out that actually from my readers, people do want to read about it. And there's been this kind of overwhelming surge of gratitude from some of my early readers saying, oh, thank God, somebody's actually told it the way it is. Yes, and that's so important. You know, 98% of people we see in my clinic have psychological symptoms. We're told for many years that the menopause is hot flushes,

it's night sweats, it might be a bit of vaginal dryness, but no one really teaches us the importance of hormones in our brain, not just estrogen, but testosterone as well. And it's often, for many of us, myself included, if you don't have those hormones, you have no idea how much they were working in your brain. And so this anxiety, this reduced self-esteem, the sort of rumination, the overthinking of things can be very common. It is, absolutely. I can completely relate. And I mean, it's strange because as with chocolate, I've learned a lot more about the topic of my book as I was writing my book than I knew before writing the book. You know, when I passed through menopause. I just, I was in a complete haze of ignorance about everything. I didn't

have any resources. My GP just said, oh, let nature take its course. And, you know, I was left thinking, A, that I was going crazy, B, that I was probably making too much of something that, you know, all women have and why was I making a fuss about it? And I just thought eventually, you know, this is it. This is the new normal. This is me. I'm beginning now to understand that that's not necessarily true. But a lot of Bernie's experiences, the feeling that she is going crazy, the physical symptoms, but also the sense that she is just disappearing from the world. That is absolutely, you know, what I felt and what to a certain extent I still feel. And that happens so much. You know, when I over my clinic, I really wanted to just work, it sounds a bit crazy when I worked so hard now,

but I wanted to just work one day a week and just see some of my friends who'd been given antidepressants for their menopause and get to help some of the mums from school. And then I developed a website, which was then called Menopause doctor. It's now called Balance-Hifammenopause.com. But I started to write about what the menopause is, what it means, what the hormones do in our body. And then I started to see people from many miles away, and this was before COVID, so we couldn't do Zoom consultations. But I remember a patient I saw, and she'd come down from Edinburgh, so she'd actually got a train, she'd got a bus, then she'd got a taxi, and she'd stayed overnight the night before. And she was 42. And she told me the last

10 years she'd really struggled, but she'd given up her job. Her partner had left her. She was a shell of her formal self. And she'd put on weight. She couldn't think about anything. She couldn't remember things. She used to be an accountant and just had stopped working. And I said, what happened to you when your symptoms started? She said, oh, it's very obvious. I know what happened. She said, I had my ovaries removed. I had some endometriosis. They said, you're a lot better without your ovaries and your womb and we'll remove the endometriosis. So it's a very successful operation. I said, yes, but they removed your ovaries that made you menopausal. Did it? She said, well, no one told me. I said, did anyone talk to you about having your hormones replaced because you're so young?

It's really important for your future health. She said, no, no one's told me at all. They said, I should be grateful because my endometriosis has gone. And I remember feeling very sad after this consultation. And my husband's a urologist. And I went home and I said, Paul, if you were taking someone's testes off because maybe they had, you know, a cancer or something, you took both their testes off, which would mean they wouldn't have testosterone in their bodies? Would they leave hospital without any hormones? He went, don't be ridiculous to me. Think of that suffering to that man. And then he started laughing and realized exactly why I was asking him. And I said, but it happens all the time. This was seven years ago. And one of our research fellows has just done an audit at his

hospital, he's a gynaecologist, looking at the percentage of women who are young, who have ovaries removed, who are given HRT. There are some women who are given HLT, but the dose is incredibly low, and they're not given testosterone, they're only given estrogen. And testosterone, we produce in higher quantities than estrogen before the menopause when we're young. So why is it that men are allowed something and women can't? It just doesn't seem right, does it? It really doesn't. And yet, we've been living with this pretty much, you know, forever.

It is thought to be woman business and men are not involved in woman business. Even male GPs don't seem all of them to feel. comfortable talking about woman business and so you're left to deal with it alone. I spoke about this slightly to my mother who came out with a spiel about how ridiculous young women were making nothing out of things that were completely normal and how she just powered through it in her day and that, you know, I would be able to do the same and I thought, okay, that's it. You know, we power through, but it's actually, you know, we don't have to. No, and I think this whole narrative that women have to suffer.

Yes. Seems really sad. It's very biblical. Yes, it is biblical. And in the old days, you know, periods were curse, weren't they? Of course. Of course. Well, and then now it was the change.

Well, what are we changing into? We're changing into something that is a shadow of our formal selves for a lot of people. Some people feel very invigorated without their hormones, but they are the minority. We know that many people have symptoms. And in fact, one of the pieces of research I'm presenting next week is a survey of nearly 6,000 women looking at unexpected symptoms of the menopause. And muscle and joint pains, dry eyes, very common, itchingness of the skin, some of the mental health issues. People weren't expecting at all. Tinitus, again, is a very common symptom.

Restless legs, poor sleep. All of this is sounding very, very familiar to me. So, I mean, we came up with 99 symptoms. If you look on websites, some people will say there's 87, there's 23, there's 64 symptoms. Actually, there's hundreds of symptoms because our hormones go all over our bodies. Yet women, I know from just looking at my social media, listening to women, is that they'll go to a healthcare professional and they'll say, no, it can't be your hormones because you haven't got hot flushes or because you're not this certain age,

or you're not this certain. And actually, no, of course, I know all the time I learn from patients. When they have symptoms, I often say, I have no idea if it's related to your hormones, but I'll give you your hormones back because we know there's health benefits of your hormones and see what's left and then when they come back and say my tinnitus is gone, my itchy skin's gone, my sense of smell has come back,

my mouth is less dry, well of course then it's going to be related to their hormones there's a lot of common sense out there and a lot of women are just being silenced actually because they're saying, no, it can't be, don't be silly, like you say, just put up with it. Maybe it's because you're not exercising or you're not eating the right food or whatever.

But we've been blamed actually for something that is out of our control. We are. We're blamed. It's like, oh, you didn't do this. You didn't eat a healthy enough diet. You didn't relax enough. You know, you should be doing this. It's the onus is on women to change even more. Rather than to actually face the changes that their body is undergoing and to accept them and to look at them. Yes. And that's part of such a bigger conversation globally as well. You know, my mission is to improve the global health of women. You know, obviously I'm starting in UK, but a lot of the reach up with balance and the other work I do is reaching women and resonating to women globally. But I've recently been to Morocco for family holiday and we're in

Marrakesh and we almost played a game with my teenage children. Let's spot the women. What are the women doing? Where are they working? They're all, of course not all, of course not all, but there's a significant number and certain countries they're still hiding because they become more invisible as they age. Sometimes they have other commitments, of course, at home. But knowing how the menopause affects people, it can affect people in other cultures and other ethnicities, of course, as well. So you're made to feel almost you should be concentrating just on your home and your family. You shouldn't have that confidence. You can't think your concentration maybe is not so good. Your ability to multitask isn't so good. Your ability to be a working woman. We know lots of women around 10% give up their

jobs because of the menopause. But actually there's something about that that doesn't seem a problem. And I don't know why. Other than it's women. I think the thing is there is a very strong underlying narrative that when you reach menopause, you are used up and you are no longer of any worth. And so trying to help somebody who is not perceived by a patriarchal society as being worthwhile seems to be a bit of a waste of time to that patriarchal society because there are lots of women who are still worthwhile, and they concentrate their energies on them. And I don't think it's anything as conscious as that, but it certainly feels that way. I mean, when you look at the invisibility of women in the media beyond a certain age and in the arts and in the acting

professions and, you know, why would you look at a woman who is over 50 when you could be looking at a 30-year-old instead? And that's really the question that they're asking, and there is no real answer. No, but you could look at 50-year-old men. men and they keep going, don't they? That's absolutely fine. Well, men are different. Men have a different visibility and men don't lose that visibility. They are not thought of as being used up because they're not seen to be primarily important because of their sexual viability during their lifetime anyway, whereas women are.

It doesn't matter how successful you are as a woman. Look on social media at the way women are treated and the way women are spoken of. And the first thing that most people notice is whether they're pretty, whether they're attractive, whether they're sexually viable. And so, you know, it doesn't matter how far you go in your profession. You can be a great athlete, but if you're not rateable to the majority of men, then that's the thing that they will focus on. And it hasn't changed. You just think over the years, you know, we're now 2023. I've got three daughters who are vehemently strong and quite feminist.

But actually things aren't easy. My 20-year-olds are musician. She's a trombonist, and most brass players are men, and she's breaking a bit of a mould. I get a lot of bullying and toxicity from all sorts of people for the work that I do. Yes, I imagine. And I've often said, wouldn't it be great if I was a man? Yeah. Because I think I'd be treated like a hero.

Yes, they would. They would take you as primarily a doctor rather than a woman. A woman doctor is a slightly different thing. And when people are asked to visualize a doctor, most people will visualize a man. And in the same way, there is a difference between a novelist and a lady novelist. And, you know, the lady novelist is not perceived to be as good somehow because men speak for a universal experience. And women speak for a women's experience, which is very unfair and also very untrue. But I also, it's not just men, actually.

some women can be really quite toxic and certainly in medicine there's a hierarchy of medicine. So my husband is a surgeon, so he's obviously very important. And even in hospital medicine, there's a big debate now with gynecologists who do a lot of menopause work. But actually my pushback is I think GPs should be doing the most, but not even just GPs, it should be nurses and pharmacists. And we have a lot of nurses and pharmacists that work with me in the clinic. We had a letter yesterday actually from a lady who'd, she'd, seen a doctor, her gynecologist, and she had had cancer of the womb, a very early stage, many years ago, and she'd gone back just for a routine check to a gynaecologist, but she was also one of our

patients in taking HRT, and that the gynaecologist had written to say, I forbid you to take HRT, you shouldn't take it, and you shouldn't be seeing these GP menopause experts. I want you to see a consultant NHS gynaecologist who's a menopause expert. And I have a real battle in that with my in my mind because I've got a pathology science degree, a first-class pathology degree. I'm a member of the Royal College of Physicians. I was a hospital doctor for many years. And then I change into general practice. I'm a fellow of the Royal College of GPs. And I'm a menopause specialist as well. So I think I've got more letters after my name than most gynaecologist. You couldn't, wouldn't you? I know more. So why is it that a doctor or a hospital

specialist can know more than me? I'm very happy to think that they can operate better than me. I can't, you know, suits it, but I'm never pretending I am. But it's this whole inequality that goes on all the time. And I mean, it's the same in any work, isn't it? This sort of hierarchy of self-entitlement. And, you know, my issue with a lot of it is that women are getting in the middle of all of this and then they don't know who to believe. Well, she's got a fancy private clinic. We can't believe her because she sits on telly and talks on this morning. But actually, they don't see all the other work that's done and the huge amounts of academic papers that I've read and contributed to. And it's really quite nasty actually when it's women going against women as well.

And then, you know, I don't quite see where people want to gain from this as well, really. That's the biggest picture of it. Yeah, I just don't think they understand quite what they're buying into. I think, you know, there are a lot of women with a lot of internalised self-hatred and misogyny and fear, mostly fear that actually they have more power than they think they have. Yes. And that's something that sometimes is a bit frightening and needs to be explored. Actually, this is what my book is all about, the fear of women's own power and how we retreat into our little boxes and we don't examine the actual influence that we have over the world and other people because it's scary, because the repercussions are scary of having power and exercising it. And sometimes it's better

just to do what the patriarchy tells you. Yes. In short term it is, obviously, in the bigger picture it isn't, but I felt that with Bernie in the book. I felt really sorry for her. I wanted to get her into my clinic and help her. I wanted to talk to her. And, you know, lots of people we see in the clinic, even before we talk about treatment, they just thank us for time. They thank us for giving an explanation for knowing there's a reason for their symptoms and a reason for some symptoms that they don't even realise are related to their hormones. But it's that understanding that they've perhaps not had from other people. And I think even with Bernie, she needed somebody to just take it to one side and say, this is what's happening. These are choices for you. You don't have to be

feeling like this. She absolutely did, yes. She should have met you really. Yes. So, but the way you write is just so beautiful. And I do want to ask you about chocolate because I don't actually eat chocolate because I have migraines and they trigger migraines. No, I don't eat that much of it either astonishingly. But when I read the book and I could still almost taste the chocolate when I even see the cover of your book and it's not a particularly long. book, is it? No, not especially. Were you surprised that the reviews that it had? It went into a film, which obviously the film was brilliant, but not as good as the books, the books are always better, aren't they? But the response that it had from people was quite something, wasn't it? Did that

surprise you at the time? I was incredibly surprised because I'd been told that if I wrote things like that, they wouldn't sell, and that they weren't fashionable. And I just ended up writing, I've always written what I wanted to write at any given time. And that happened to be what I wanted to write. And I was lucky enough for it to be, I think, different enough from what was fashionable and what was expected to attract somebody's attention. And then it became a word of mouth success. But I wasn't, no, I wasn't thinking about it at all. I just thought, hey, what if I wrote a book that was a kind of metaphor for tolerance? And I'm quite keen on the idea of using magic or some kind of supernatural power as a metaphor for something else.

So actually, you know, broken light and chokola are not a million miles apart in that respect because both of them have a central metaphor which is about women's magic, women's power. And how it's expressed. Unfortunately, poor Bernie's power is not expressed through chocolate and doesn't generally bring people joy or even bring her joy. But that's really how it works. She has this inner fire which comes out in these hot flushes or flashes, as I call. them because I want to make the distinction between the symptom and what she is actually experiencing, which is much more of a neurological process and possibly also a paranormal process. But yeah, I mean,

I just love writing about that sort of thing and the way different people perceive their world. And it's very interesting because this book obviously talks a lot about the menopause. I've brought a book out recently called The Definitive Guide to the Peri Menopause and Menopause, and it's got into the number 10 Sunday Times books, but I was talking down in Waterstones at Piccadilly two nights ago at an event, sold out event, and they had some books left over, so they said, can you sign them? And I said, yes, of course. I said, where are the books going? Oh, they were going up on the third floor. I said, right, it's a Sunday Times bestseller. Is it not going on a table at the front of a shop? I've come all the way down to London to do this. I'll have to talk to the manager.

And I know it won't be. It will be down in health and well-being under pregnancy books in the corner. and something that affects 51% of the population, I think, deserves to be on a table. It really does, yes, it does. And I've said to the publishers, can it go into Tesco's and Asda and Sainsbury's and the supermarkets? Oh, no, they're not keen on that. They like diet books. They like cooking books. So I'm quite sweet.

It's not seen as an upbeat topic. It's seen as a bit of a downer and people don't want to think about it because, you know, it depresses them and frightens them to think about it. But actually, those are the things we should be demystified. And they are the things, they're the conversations we should be having. Because all these diet books and these other self-help books are seen to be hopeful. But actually this too is self-help. And, you know, people are living longer and longer nowadays.

You know, you can expect to live another 30-odd years after you hit menopause. You know, you want to be happy during that time. You want to be healthy. Absolutely. And so one of my research interests is inflammation and longevity. So we know that hormones are very anti-inflammatory. in our body and so we know that women who take hormones have a lower risk of diseases and it's not about the age that we die it's a journey to get to that age and it's about being as healthy as we can

because also none of us want to go to doctors none of us want to be ill of course but I'm very scared of osteoporosis and I'm also quite scared of dementia I've doctored enough people in nursing homes who have both osteoporosis and dementia and you know ways of reducing risk of disease are really important So it shouldn't be seen. When you talk to men about menopause, people think, oh, it's just women who are a bit annoying. Women moaning. Women, old women moaning, basically. That's what they think it's going to be.

But you also think it's actually women who aren't having sex. That's quite a big thing. And women who aren't putting back into the economy because they're giving up their jobs or not going for promotion or working part-time. So that's the only way I think people are thinking about it. I think so too. Yeah, which is wrong. Yeah, absolutely. And there's also a kind of disgust in women's bodies and what they do.

We're discussed based on ignorance. And this is a disgust that goes to old women and fat women and women with different bodies. And, you know, we don't want to see them apparently and we don't want to talk about them. Well, you know, it's time we changed that. Absolutely. I mean, we've just funded a surgeon in Uganda to complete her training. and she does a lot of work for women who've had fistula's in pregnancy. And obviously when you've got scarring in your perineum,

when you become menopausal, the tissues can become very thin and fragile. And a lot of these women have urinary incontinence. If you have urinary incontinence in some places in Africa, you can't go to church, you can't have a relationship, you can't have a job. And my husband's urologist, he does charity work in Africa, who's just come back from Milawe, and he does amazing reconstructive surgery that means that these men don't have to have catheters.

And it's incredible because then they can get back to work and everything else. He went with some women, female surgeons, who were looking at the scoping for helping females with surgery. I said, why don't they just have some hormones? If they had some hormones vaginally, it would really help urinary symptoms without the need of surgery for many women. Oh, can't do that. It's too expensive, can't do it.

It's dirt cheap over here. And it would be transformational for these women, but they can still hide. matter if they don't have jobs in the same way that for men and it's um this is where i'm talking about a global problem but women aren't listened to it's like it's well it's just one of those things isn't it and then you know their life expectancy isn't as high as over here so does it matter that they have urinary symptoms for less time of course it does yes it does for a day in my mind so there's a lot we need to change i mean how do you see the future i mean do you see that women are listened to more

Do you think they're becoming less invisible or more invisible, Joanne? Well, it depends on which women. I think both of us are white women with a platform and we have voices which are likely to be heard more than if we weren't. But I think it's important for us to understand that when we see progress, we generally see progress for ourselves. But we also have to look to see if other women are also making progress. So it's interesting that you're talking about women in Uganda

because very clearly there isn't a lot of progress being made for them. And we have to see this as a women's problem, not just a you and me problem. So I'm hopeful because we're having this conversation. And I don't think that 20 years ago we would have been. I'm also hopeful because other high-profile women in the media and in the arts are also talking about this. And I'm hopeful because a big movement like me too has empowered women to, use their voices at a time when I think some of them thought that they didn't have voices. And that too is important, but I think any progress is slow. Any progress always gets an incredible amount of pushback,

which is why high-profile women like you and me are constantly getting abuse in the media and getting knocked down and being told to shut up because actually that comes from a place of fear. And this is something we have to power through, actually. It's not something we can just back away from. But I'm hopeful, but I don't expect to see change immediately because unfortunately change does take such a long time. And we also have to get people who are not experiencing this to understand that it's also partly their problem. And that is a harder conversation to have. It is. But I think we're getting there. I feel I take two steps forward and one and a half back. And there are many days that I just want to run away and stop. And then my husband says,

No, Louise. Come on. Don't do it. Think of these stories that you hear, the people that you've helped. Absolutely. It's still forward motion. It's still forward propulsion and we have to see it that way. But yes, it's very frustrating, very exhausting. And thank you so much the work you do because it's really important. Oh, thank you. Well, thank you for writing this novel. And I hope that it is going to be in front tables, in bookshops and not tucked away. And it will hopefully just generate just a bit more thought. I think there's a lot of professional curiosity that's gone in the menopause, and we need to get this curiosity back, not just for healthcare professionals, but for women, for men.

And the more they read in unexpected places, including your wonderful novel, it's going to really help. So I'm really excited, and I wish you every luck with the launch. And before we go there, I'm going to put you on the spot because I always ask for three take-home tips on the podcast. So I want to ask you three reasons. why I should recommend that others should read your book? One, okay, because it is not just a women's experience, it is a universal experience.

The way women feel shape our world or should, and they shouldn't be ignored. Two, because you are a woman, and because at some point it will be your experience. Three, because you are a man, and it's also going to be your experience at some point, and you need to know more about your world and you need to have more curiosity and I can give you a fourth too because it's jolly good fun. Oh, good, yes.

Yeah, that I like fourth. We'll keep that one. That's okay. So brilliant. I've really enjoyed talking to you today and I'm very grateful for your time. So thanks for being a guest today. Thank you so much for inviting me.

Thank you. For more information about the perimenopause and menopause, please visit my website, balance, menopause.com or you can download the free balance app which is available to download from the App Store or from Google Play.