Taking control of your menopause with Dorothy Byrne

Dorothy Byrne returns to the podcast this week to discuss her previous role as former Head of News and Current Affairs for Channel 4 television and the commissioning of and reaction to the menopause documentaries. She also updates us on her new role as president of Murray Edwards College, Cambridge University – one of only two higher education institutions in the UK for women only – and how she hopes to inspire young women especially in the fields of medicine and science.

During the conversation, Dorothy shares some of her experiences of how a menopausal lack of sleep affected her at work, why she continues to take HRT in her 70s, and the ongoing systemic gender discrimination in medicine and the workplace.

Dorothy’s advice to women who are struggling to get menopause treatment:

1. Go to your doctor and ask for accurate, up to date information about HRT, and if they are not able to provide this, ask to see another doctor
2. Don’t think you just have to put up with your symptoms
3. Don’t be embarrassed by anything related to the menopause. If something’s going on ‘down below’, find out what the cause of it is, it may well be the menopause and there are effective treatments available.

Episode Transcript:

Dr Louise Newson [00:00:09] Hello, I’m Dr. Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre, here in Stratford upon 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 in the studio, I’m very delighted to introduce to you Dorothy Byrne, who some of you might know already, and you’ll all know by the end of this podcast who she is. But I was introduced to her a few years ago by Kate Muir, who is the inspiration behind the Davina programme and Kate and I are very good friends. We have been for a long time. And she said to me a while ago, you’ve got to meet Dorothy. And I did and I’ve been completely inspired by her work and it’s incredible what she’s doing. Dorothy, welcome today to the studio.

Dorothy Byrne [00:01:17] Thank you very much indeed.

Dr Louise Newson [00:01:19] So you’re doing a different role now from when I first met you, which we will talk about in a minute. But when I met you, you were working for Channel 4 weren’t you? So do you mind explaining what you were doing then and also how you got to your job as well?

Dorothy Byrne [00:01:32] So previously I was Head of News and Current Affairs at Channel 4 Television for about 15 years, and I’ve had a career in television spanning 40 years. And still, in fact, work executive producing television programs. So, you know, I ran Channel 4 News and Dispatches, but quite a long time ago, I was a television producer/ director on a program called World in Action. And I’ve made programmes about all sorts of different subjects, but I’ve always felt it was important as a woman to make programmes about issues that were important to women. I’ve sometimes heard women say in TV, ‘Oh, don’t make programmes about women if you’re a woman because you’ll get stereotyped’ To which I say, well, if we don’t make programmes about women, men aren’t going to do it, so we need to do it. For example, the first programme I ever produced and directed was about rape in marriage, which was then not a crime. And the last programme I commissioned for Channel 4 was about the menopause and that programme ended up being presented by Davina McCall. It was produced by the brilliant Kate Muir, who’s since written a terrific book about the menopause and really brought about a sea change, I think, in the country. You were the medical consultant on it.  At the time that I commissioned it,  some men said to me, well, only old ladies will watch it, and I said, well, luckily there are a lot of us. But in fact, I pointed out that a programme about the menopause is of interest to all women because nearly all women will go through the menopause. And it’s also of interest to men because they are related to women and they are the bosses of women and they’re the friends of women. So I mean, the programme ended up being so successful that they made another one, and I think they’re in the middle of making a third one. And I think it is probably the cause of the run on HRT that temporarily occurred. And I ended up, ironically, being one of the women who couldn’t get her HRT. And I can remember blurting out this is an outrage, who is responsible for the fact that there’s a shortage of HRT? And then I thought, oh, maybe it’s me because I commissioned that programme. I should have kept quiet about HRT and then I wouldn’t have run out of it. And actually a very nice woman lent me some HRT to keep me going because one of the things about HRT is once you’re on it, it’s so fantastic and life changing that the idea of going back to life without it is most unpleasant.

Dr Louise Newson [00:05:11] Absolutely right. And there’s a couple of things there that I think firstly, to just talk about the Davina programme. It’s been really monumental actually in medical history I think as well. And I know when Kate and I first talked about even her putting this programme as an idea, we felt almost cheekily naughty even thinking about it. And then we were thinking, well, how is it going to be taken seriously for a documentary and would it make a difference? But it’s made such a huge difference, but now it’s almost tipped the other way because there are a lot of criticisms actually, from other medics often say, well, women want to look like Davina. That’s why they’re taking HRT. It’s had this Davina effect and I think we’re forgetting the science behind the programme. And the programme has been done, hasn’t it, in a very evidence-based, scientific way. It’s not just for sensational telly. It was done because there was so much that was forgotten about what the menopause is and means and the treatment that’s available and, you know, it was all based on the NICE guidance, which is now seven years old. And it really horrifies me as, you know, every day I wake up thinking about how to reach more and more women who are just being neglected. And it seems wrong that we’ve got this guidance, we’ve got papers, we’ve got articles. Yet it’s a Channel 4 documentary that has made the biggest difference for treatment being actually offered and prescribed to women.

Dorothy Byrne [00:06:36] Well, I think what it did as a programme was create the demand by women who then went to the medical establishment, generally their GP, and demanded HRT and said the information that you gave me on HRT was wrong. I’ve watched this programme and when you told me I just had to put up with the menopause or it’s just natural when you get older to not be able to sleep at night, you know, I put up with that, but that was not true. And this does happen from time to time with television. Television, it’s often maligned, but from time to time it creates a public demand for a policy change. And that’s what the programme did. I think it’s absolutely insulting to women to say they only want to go on HRT because they want to look like Davina McCall. I’m 70 years old. I’m not going to look like Davina McCall. It would be weird if I looked like Davina McCall. People would think, you know, I’d become one of the undead or something. That’s not what I want. What I want is to sleep at night, which was my biggest issue. So I have the energy to live my life. Nor are women like myself who find that HRT has transformed their lives, saying all women should take HRT. You know, women can do what they want. They can make decisions for themselves. For me, I suffered for years, particularly because I couldn’t sleep. And that was the overwhelming reason that I went onto HRT. It’s also the fact that I come from a family which has high levels of osteoporosis, you know, is influencing me in the background. And I know that HRT can also help to reduce the likelihood of heart problems, I’ve probably not said that quite medically, accurately. But if I didn’t have the overwhelming sleep problems, I might not have gone on to it. However, the fact is that when I last went to see a medical consultant who looked at the uptake of calcium in my blood is, I think, the way it’s put, she said. That is really good for a woman of 70 who comes from a family with osteoporosis who, because of the disease I had, was on steroids for three and a half years. And she said, that is almost certainly because you’re on HRT. So that for me personally is another really good thing. But each woman to her own, it may be some women are absolutely fine, and that’s great for them.

Dr Louise Newson [00:10:20] I totally agree. And that’s what’s I think it’s really interesting. When I first started my menopause clinic now seven years ago, I started to see women who I now see all the time, but women who tell me how they’ve been refused HRT and they’ve been really suffering and they’d given up their jobs and their partners had often left them and their lives were pretty miserable and often saying, I feel like I’m existing rather than living but I can’t get HRT. And so I went to my first menopause conference and I spoke to some menopause specialist there who were very senior, very learned people in their fields and said to them, I’ve listened to these stories, this is horrendous. And they said oh Louise, it’s been like this for years. This is the way it is. And I sat in these lecture theatres which were empowering me, telling me about how safe HRT is, how effective it is, as you say, for prevention and treatment of osteoporosis, for reducing heart attacks, for reducing dementia, type 2 diabetes and thinking, well, why aren’t people knowing this? And I thought, well, I’m not strong enough and academic enough to educate healthcare professionals in actually in a way that I do now. But then I was on my own and I was just starting, so I thought, well I’m a bit of disrupter I suppose, I’ll disrupt the system in a different way and allow women to have the information. And then I feel very strongly about shared decision making. And I feel as a physician, I’m not dictatorial. It’s entirely up to the patient what they want, as long as it’s reasonable and they have a balanced consultation knowing if there are any risks, but also benefits of treatment, but also which I think is really important here, the risks of not having treatment. And I think what has happened now is that women have overwhelmingly often decided that the benefits outweigh any risks. And like you say, for some women they don’t want it, that’s absolutely fine. But a lot of women now are thinking, right, if I don’t take HRT, I have this increased risk that you say of osteoporosis or heart disease or dementia. And actually for my future health, I would like to take HRT and I personally take HRT. I really don’t want osteoporosis and I’m really not keen on dementia, so I do take it for health benefits as well as being able to keep my job because it helps me work. But the thought of looking like Davina is not on the top of my list. As women, you know, we’re allowed to make decisions and we shouldn’t have information withheld from us, which is what’s happened for 20 years. We’ve not only had information withheld, but we’ve also been given wrong information about HRT. So, you know, the momentum from the programme, from work I’ve done, work from others have done, is allowing women to make a choice which is so important.

Dorothy Byrne [00:13:00] Well, I think looking at my family, my mother and my grandmother ended up as those old ladies who are so bent over that they can’t look ahead of them. And that is obviously a frightening prospect for me. But also I’ve looked at some of the statistics about the likelihood that you will die if you fall over and break your hip aged 80 plus and they’re really frightening figures. So everybody talks and thinks about cancer and they should. But probably if I look at my family and its medical history, the bigger danger to me is osteoporosis and what would happen to me at the age of 80 plus if I fell over. But also as I began to feel less and less confident about moving about and therefore took less exercise and all the effects that that would have on my health. So I think there’s actually a general problem in the United Kingdom about the fact that we have very poor treatment for cancer as it happens, compared to other Western countries. But cancer’s the disease that gets talked about all the time, not all the other causes of death, and particularly with women, heart disease as a cause of death is barely talked about and the effects on the heart of older women of going through the menopause.

Dr Louise Newson [00:15:05] Hmm. Absolutely. I mean, I was taught in medical school, actually, that women are protected from heart disease until they reach 50, and after that time they are less protected, which is obviously so it’s so obvious now, thinking back, it’s about hormones, but never mention the word estrogen or hormones. It was almost like it was an age thing and nobody joined the dots. But the more work I do in this area, Dorothy, the more I realise that there’s so much antagonism, there’s so much toxicity out there, but there’s also a lot of suppression of women being allowed this choice. There’s, you know, we know there’s been HRT shortages, we know the government aren’t really addressing this. And it’s almost like it’s a there, there, just be quiet we’re a bit bored of the menopause now would you just go back and carry on with self-care and open water swimming and whatever else and try not to take HRT almost. And I think a lot of it is because it’s women. And I never really thought well many years ago that I was really a feminist, but I probably am. But why is it that there’s such a gender difference? And a lot of people say to me, well if it was men that were suffering in the same way it wouldn’t be such a mess. And, you know, you now work differently, and I am keen to hear why you’ve got your role at Murray Edwards College but you know, it’s a women’s college and there’s still gender inequality, isn’t there? Why is that?

Dorothy Byrne [00:16:26] Well, why is there a gender inequality? That’s a huge question, isn’t it? I mean, I’ve taken this job as President of Murray Edwards College at Cambridge University, which, as you say, is a women’s college, one of only two higher education institutions for women in the UK. Because I think it’s really important to help give girls and young women the chances and the opportunities which we didn’t have, and to encourage them to be confident and specifically to encourage more young women to go into science and to carry on and do further degrees in science. I think medicine and science have always had a misogyny of their own. And, you know, from women being expected to put up with all sorts of pain and discomfort from the moment their periods begin right through to after they go through the menopause, you see that great misogyny. And a lot of that has been about keeping women ignorant. And if you look at the history of women and medicine, you know, you can read about the Victorian era in which women were treated as hysterical and that word coming from the word for the uterus and women being treated as if they are mad, if they have various medical problems, women being treated in grotesque ways, if they were thought to be too interested in sex and then being blamed, if they weren’t interested in having sex with the horrible man who they were forced to marry. You know, if you were to write the history of misogyny in medicine, it would be in several volumes. And I think the way that the medical establishment has treated the menopause is just a little part of that. If I think when I was a girl, having your period was called the curse, look at that word that we used in my convent that you were cursed as a woman. I mean, that’s like, God, you know, we already have original sin and now we have an extra curse, the curse of womanhood and all the difficulties that girls had with their periods, some really severe, which meant that they did very badly in their O-levels and A-levels and never went to university. I mean, all that is only just changing now. The fact as well that when couples can’t have children, everybody always assumes it’s ‘the fault’ of the woman and people still talk about ‘fault’. So all the way that you go through every stage of a woman’s life, she is discriminated against. And the key thing about feminism, the number one thing is seizing control of your own body, saying, I have the right to have a child or not have a child as I want to, and I have the right to the latest medical treatment informed by massive amounts of research when I decide what I judge is right for me when I go through the menopause and I think seizing control of your body in the menopause is a feminist act of the highest order.

Dr Louise Newson [00:20:58] I couldn’t agree more. And, you know, I was at a high level meeting recently, and they were saying it’s actually outrageous that women in their 30s are now asking for hormones and women in their 40s. How dare they? And I’m there saying, but one in a hundred women under the age of 40 have an early menopause. I see lots of women in their 30s and 40s who have symptoms which may or may not be related to their hormones, but they likely are. And often I’ll say to women do you think it’s related to your hormones? And they say, Oh, yes, because it’s very similar to how I used to feel a couple of days before my periods. So as you know, there’s no diagnostic test for the perimenopause or menopause. Often it is almost like a gut feeling. It’s a group of symptoms that are likely related with the woman actually saying, I think it’s my hormones and so the only thing I can do as a doctor is say, well, I can give you some hormones and let’s see what happens. And if in three months’ time you’re feeling no better at all, it’s unlikely to be your hormones. But that’s fine. They have an informed decision making consultation. They try HRT knowing it’s fully reversible if they don’t want to continue. And I’ve only known one patient in the seven years I’ve been doing a clinic who’s come back and said, I don’t feel any better at all. So I don’t see why we cannot be not believing our patients. I don’t see the advantage of being a menopausal woman. There’s this whole thing, even in the workplace, that if we make too much fuss, women will use the menopause as an excuse to go off sick. Whereas I don’t think it’s something that we’re necessarily proud of. It’s something that happens to us usually naturally as we age. But it can be iatrogenic be caused by treatment or surgery, but it’s something that we want treatment so we can enable us to carry on working and everything else. And I know you’ve just written a really great piece actually in one of the newspapers about why women are giving up work and how we should be able to have treatment. And like we said, some of us want treatment to reduce risk of diseases, but other ones have treatments so that we can feel better and stay in the workplace. And is that a bad thing that we want to carry on working and functioning as highly functioning women?

Dorothy Byrne [00:23:12] Well, of course, now the irony is that the government is very keen for older people not to leave the workplace because of this crisis of what they call the millions of missing workers. And one estimate is that nearly a million of those missing workers are actually women who gave up work, didn’t want to give up work, but they gave up work because they felt they couldn’t cope because of the menopause. Now, the figure that Jeremy Hunt, the Chancellor of the Exchequer, was referring to was about 300,000 people who have left the workforce since the pandemic. But if more than three times as many women as that left work grudgingly because of the menopause. A really good answer to this lack of workers is to encourage every employer to have a good and informed menopause policy, and then women wouldn’t leave work. I don’t think there’s evidence that women use the menopause when there’s menopause policy to take time off sick. No, there are always people who want to take time off sick when they’re not really sick. They don’t need to use the menopause to do that. There are lots of ways in which they can do it, but it’s much more likely to be run the other way that the woman goes on and on struggling through her work, and then in the end, one day just goes, I can’t take it anymore. I’m just too overwhelmed by it all. And that’s the reality. I mean, for me, before I went on to HRT, I was waking up every 1 to 2 hours. That was for several years. And if I slept 3 hours at a time, I regarded that as a really good night. And it meant that when I was at work, bear in mind I was making TV programmes, so if the lights were turned down a bit in an edit suite to watch a programme, there were a couple of occasions in which I just fell asleep because I was constantly so exhausted. I once fell asleep in a major public lecture being given by my boss when I was sitting in the front row. And obviously she assumed it must be because I found her boring or it was some deliberate insult and it was an appalling thing that I did it, but I was just so, so tired all the time. When I went onto HRT. You know, when you get better and there was a problem before. Often you don’t notice immediately that it’s much better. You just get used to it. And I think it would be after about six weeks that I suddenly realised I sleep at night and then I had much, much more energy and I now work full time and I’m 70 and I feel really energetic most of the time. I don’t have the levels of energy that I had when I was 35. I don’t expect to have those levels of energy when I was 35. I could work till 2am and then get up at 6am, I could work without eating. It’s not like that. It’s different when you’re older, but I can definitely work full time and it feels natural to work full time, and I feel I’ve got a lot to offer. The idea that when women are 50 plus, they’re just not needed anymore. Well, that’s an outdated view by some in society. But the economy needs us. And look at the pension age: 66 likely to go up to 68. If you don’t give women help with their problems with the menopause and they all start giving up work at 55, the economy is going to be in deep trouble.

Dr Louise Newson [00:28:09] Which absolutely it already is and we know around 10% of women leave their jobs directly because of the menopause. Often symptoms such as anxiety, memory problems and fatigue, as you say. And it’s completely underestimated. But we also know a lot of women are not going for promotion or they’re going more part time and not through choice. And anybody who goes part time obviously is going to be paid less. And, you know, that’s really bad for the household, but also for the employer as well. He’s going to have to find more work force, which is going to cost more money to recruit someone. And it goes on and on and on. And we see it all the time. But some women just say, well, of course, now I’m menopausal, I can’t expect to work at the same. And I think, goodness, that’s really sad as well, because actually as older women, you know, we’ve got more experience. We’ve worked so hard on our careers. The last thing I want to do is as a doctor is to just sit home and make supper for my husband every day because I can’t think of anything else to do because I feel so awful.

Dorothy Byrne [00:29:13] Well, we can’t afford doctors like you to give up. It costs £160,000 to train a doctor and if there are so many doctors retiring in their mid-50s, there’s an absolute crisis. So the number one group who need good menopause policies and advice, I would say, is the medical profession itself. But as I understand it, certainly until recently, medical students only got about 30 minutes in their whole medical training about the menopause. Something that’s going to directly affect half of their patients. I don’t know about you, when you were at medical school, how much training did you get?

Dr Louise Newson [00:30:07] I think 30 minutes is quite generous Dorothy, I don’t think I got as much as that at all. And, you know, when I did, it was just something that causes a few hot flushes and when I was doing medical training through all my jobs, I was never taught about the menopause at all. And I think back, you know, doing cardiology jobs where women came with palpitations, I did a rheumatology job, lots of pain with muscle and joint pains. I did a neurology job, lots of people with migraines. I did a psychiatry job, lots of people with low mood who are women, never even thought about menopause. Even working in casualty, I’d often see people coming in with total body pain and that had all the tests under the sun and said, No, there’s nothing wrong with you. You must be depressed. Well, of course they could have been menopausal. So even urology, seeing women with recurrent urinary tract infections, you know, the list goes on and on and on. And the only regret, I don’t have many regrets of my life, because you can’t change the past, but I do wish I could turn the clock back and just think about hormones and more and more of these women that I saw because I think I could have given them very different lives. But we are where we are. The knowledge is there. But I think the most important thing is for women to have that knowledge as well and being able to use it but be listened to. So I’m very grateful for your time today, Dorothy. But just before we end, could I just ask for three things that you think women can really do that’s going to make a difference for their future going forwards if they are menopausal or perimenopausal and maybe struggling to be listened to, what would you say they should do?

Dorothy Byrne [00:31:43] Go to the doctor and demand the right to proper information about HRT and say to the doctor, well, if you don’t have it, transfer me to another doctor. Secondly, don’t think you just have to put up with it. And thirdly, don’t be embarrassed by anything about the menopause. You just referred to urinary tract infections. That’s something that a lot of women don’t want to talk about and they assume has nothing at all to do with the menopause. But if you’ve got an embarrassing thing going on, as we used to say at school ‘down below’, I would find out what the cause of it is. Don’t just put up with it. And it may be you don’t have some terrible personal problem, it’s the menopause.

Dr Louise Newson [00:32:46] Absolutely. So talking until your are listened to  and make sure you’re taken seriously is really, really important. So thank you ever so much. It’s been such a delight talking to you today. Thank you.

Dorothy Byrne [00:32:56] Thank you very much. It’s always a pleasure to talk about the menopause.

Dr Louise Newson [00:33:02] For more information about the perimenopause and menopause, please visit my web site balance-menopause.com or you can download the free Balance app, which is available to download from the App Store or from Google Play.

END.