WASHINGTON — As the population of women over age 50 in state and federal prisons continues to rise, their exclusion from menopause health care is becoming an increasingly pressing issue.
“We found an alarming lack of institutional policies about a major and unavoidable life stage that a significant portion of incarcerated women will experience,” stated the Prison Policy Initiative. “Currently, there are no existing national or international standards of care for menopause in prison,” as men were more of a consideration in the design of the U.S. prison system than women.
The Prison Policy Initiative, in its search for existing research on menopause during incarceration, found only a policy handbook for women’s prisons and documentation from 10 states that mentioned the word “menopause.” Of the 10 states’ documentation, “none spell out what medical care, education, or resources prison officials provide to people experiencing perimenopause or menopause,” and “only five actually have information explicitly about menopause.”
With incarceration as an added factor, women in prisons often have restricted access to common items that may help alleviate their symptoms, including air conditioning and over-the-counter medications. Incarcerated women also have even more restricted access to education and information regarding menopause than other women, a lack of resources to help identify their symptoms, a loss of individual agency and may even face discipline and punishment for their symptoms.
“Women are almost entirely reliant on their peers for information about menopause,” said the Prison Policy Initiative. “While peer support is important, it should not be the only avenue for information and care available to incarcerated women.”
Incarceration inhibits women from being able to access “resources to determine if their symptoms (such as mood changes) are even related to menopause or, for example, a response to the trauma of incarceration,” according to the Prison Policy Initiative.
Women in prisons also have little agency over their decisions, actions and environment, leading many to experience a lack of control and privacy when attempting to manage their symptoms because of their inability to “use common remedies freely (like showers or menstrual products).”
Incarcerated women have even described being punished for symptoms such as soiled clothing or bedding.
The Prison Policy Initiative said “some women shared a perception that experiencing menopause in prison is, in and of itself, part of their punishment.”
Stories of experiences from incarcerated women across the country align with the findings of the Prison Policy Initiative.
Kwaneta Harris, an incarcerated woman in Texas, began to develop intense shoulder pain in 2019. She then started having heart palpitations and tachycardia, an abnormally fast resting heart rate.
As a former nurse, Harris was “quick to diagnose,” according to the Marshall Project. Believing she had a thyroid problem, she attempted to see an endocrinologist, but even after months of trying to get help, remedies that were recommended to her failed.
Three years later, Harris stumbled upon a TED Talk about perimenopause and “suddenly, the constellation of medical symptoms all made sense.”
Harris wasn’t able to receive the medical help she needed right away, however. She had to wait another two years before she was able to get a prescription for Premarin, a hormone replacement therapy, or HRT.
“A provider agreed to prescribe a 60-day trial supply after Harris pleaded for relief, in tears,” detailed the Marshall Project. “The prescription was never refilled when it ran out.”
Lori Pults, an incarcerated woman serving a life sentence in Missouri, remembers being suddenly overcome by heat while lying on her bunk bed and mistakenly thought she had a fever rather than her first hot flash.
While Pults was able to be informed by a nurse practitioner at the prison that she was experiencing a symptom of menopause, others are not so fortunate.
“There is no information whatsoever available for women on this topic,” said Ann, an incarcerated woman serving a life sentence in New York. “There was never any effort by anyone to get me any information when I asked about menopause. I would have to ask a friend to get me information off of the internet.”
Linda Cayton, who is being held in North Carolina, described the methods she would use to try to alleviate the discomfort of hot flashes. “Cayton filled every little vessel she could find with cool water — empty pill bottles, cups and shampoo bottles — and took them to her cell,” the Marshall Project reported.
“An older woman advised her to wet her clothes to get through the night (and to do so at a certain time to avoid getting caught by guards),” the Marshall Project said.
Harris states that women in her prison are often denied a sufficient supply of menstrual products even though perimenopausal women typically experience heavier bleeding during their periods. Women are forced to rip up sheets and use them as a replacement for pads and tampons, which is then “punished and written up as ‘destruction of state property.’”
Published by the Marshall Project, Harris created a guide: “How to Navigate Perimenopause and Menopause in Prison.”
This guide provides information defining menopause and perimenopause, as well as the symptoms that come along with each. Harris also included information on how to advocate for medical care while incarcerated, what may be accessible for symptom relief, as well as the medical interventions that are available to incarcerated women.
California, and now Arizona and South Carolina as well, have the Menopause Project, which strives to “overcome the lack of information on menopause in prisons, producing physician guides and trainings, educational material for providers and incarcerated people, and ‘town halls’ and workshops to empower incarcerated women to better understand and advocate for their own health,” according to the Prison Policy Initiative.
While “preliminary data collected by the Project suggest that the program improved connections between individuals and necessary medical care, closed the knowledge gap among providers, and increased awareness of menopause and related symptoms among staff and incarcerated women,” much work still needs to be done to overcome this challenge.
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