Had this guide existed during my years of confusion, suffering and self-doubt, my experience with menopause would have been far more legible to me. Instead, I experienced gaslighting, racism and disbelief. Before my incarceration, I was a nurse. I sat through years of medical education, memorized pharmacology charts and learned to assess patients from head to toe. Yet, no one — not one professor or clinical instructor — ever taught me what it’s like to experience perimenopause. When my own body began its transformation, I was blindsided. The guide you are reading now is everything I wish someone had handed me: Clear explanations of what menopause, perimenopause and surgical menopause actually are, honest accounts of the physiological and emotional changes that accompany them, and practical guidance for navigating a prison medical system that was not designed with our bodies, or our dignity, in mind.
This guide exists because incarcerated women deserve more than guesswork and dismissal. Here you will find the language to name what you are experiencing, the knowledge to recognize symptoms others may have told you were "just stress" or "all in your head," and strategies for advocating for yourself when medical care feels like a locked door. Information is not a luxury — behind these walls, it is survival. Consider this your permission slip to stop suffering silently and start understanding your own body with the clarity and compassion you have always deserved.
Kwaneta Harris is currently incarcerated in Texas.
If you have a loved one in prison going through perimenopause or menopause, you can request "Know Your Reproductive Rights in Prison: A resource guide for healthcare access and decision making during incarceration" for free from the California Coalition for Women Prisoners using this form. The form requests a CDCR ID number, but the guide can be sent to people incarcerated in any state. Please include your loved one’s ID number in the comment section if they are not in California. While the guide includes some California-specific legal information, much of the guide, including the menopause section, is relevant to all incarcerated people navigating access to reproductive care.
In this story:
- What is menopause?
- What is perimenopause?
- What is surgical menopause?
- What is treatment-induced menopause?
- What perimenopause symptoms might you notice, and when might you experience them?
- How can I talk to my medical provider about perimenopause and menopause while incarcerated?
- What specific kinds of medical relief can I request?
- What non-medical options for symptom relief could I request?
What is menopause?
Menopause is diagnosed after someone has not had a period for 12 consecutive months. It means your ovaries are no longer releasing eggs for fertilization, and you can no longer become pregnant. “Menopause” describes a singular point in time, when your period has stopped, rather than the span of time during which someone’s periods might become irregular or when hot flashes might begin. On average, menopause occurs between the ages of 45-55, but it can occur as early as your 30s (or earlier, if your ovaries are surgically removed).
What is perimenopause?
Perimenopause describes the period of months or years that lead to menopause. Also referred to as the “menopausal transition,” perimenopause can cause a wide range of physical and mental symptoms, which we discuss below.
Perimenopause is triggered by the slowed production of estrogen and progesterone, and can last anywhere from a few months to 10 years. The average duration is three to four years. While symptoms can be very disruptive for some women, they are mild for others.
During perimenopause, it is still possible to get pregnant. It is possible to contract sexually transmitted infections both during perimenopause and once you are in menopause.
What is surgical menopause?
Menopause can be surgically induced by any medical procedure in which both ovaries are removed. (The medical term for ovary removal is “oophorectomy.”) People can enter surgical menopause at earlier ages than most people naturally begin perimenopause. If only one ovary is removed, you are less likely to immediately enter menopause, though you may experience some symptoms and may ultimately begin the menopausal transition earlier.
A doctor might recommend an oophorectomy for a variety of reasons, including: treating endometriosis, treating or reducing the risk of cancer, removing non-cancerous cysts, treating infections such as pelvic inflammatory disease, or addressing ovarian torsion.
A hysterectomy, in which the uterus is removed, will not induce menopause unless the ovaries are also removed. People who have had a hysterectomy will no longer get their period, but will still produce estrogen; they cannot become pregnant, but can still contract sexually transmitted infections.
What is treatment-induced menopause?
Certain cancer treatments — such as chemotherapy, hormone suppressive therapy and radiation to the pelvis — can trigger menopause. Depending on your age, treatment-induced menopause (sometimes referred to as “chemopause” or, alongside surgical menopause, as “medical menopause”) may be temporary or permanent. This kind of menopause can happen much more quickly than non-treatment-induced menopause, in a matter of weeks following your treatment or medical procedure.
What perimenopause symptoms might you notice, and when might you experience them?
Perimenopause typically begins in a woman’s mid- to late 40s, but it can also begin in your 30s or 50s. This period of time can be marked by a range of symptoms, not all of which will be experienced by everyone. Changes and symptoms some people experience include:
- Hot flashes or night sweats
- Fatigue and insomnia
- Joint pain
- Acne or dry skin
- Irregular periods, or heavier or lighter bleeding
- Forgetfulness and trouble focusing, also referred to as “brain fog”
- Vaginal dryness and lower sex drive
- Changes in mood, including irritability, mood swings, anxiety and depression
- Weight gain
- Thinning hair
- Needing to pee more frequently
These changes are caused by hormonal fluctuations, specifically by declining levels of estrogen and progesterone. While these hormones are the primary drivers of the menstrual cycle and sexual development, estrogen also influences bone growth and health, brain function and mood regulation. Progesterone influences the cardiovascular and respiratory systems, in addition to affecting the central nervous system, the immune system, kidney function and the stimulation of appetite and weight gain.
Perimenopause is generally not formally diagnosed, and it can be unpredictable — symptoms may stop and start again over a long period of time. For many people, skipping a period is one of the first signs.
Black women often enter perimenopause earlier and endure more severe symptoms than non-Hispanic White women, including more frequent hot flashes and night sweats and higher rates of depression and anxiety. Black women are more likely to have fibroids, and therefore more likely to have their uterus and/or ovaries removed than other groups, increasing the odds of earlier menopause.
How can I talk to my medical provider about perimenopause and menopause while incarcerated?
If you think you might be in perimenopause and are interested in medical relief, you should submit a request for sick call — or request an appointment with a medical provider however your prison requires you to. Dr. Jennifer James, a researcher and scholar whose work focuses on the patient-provider relationship in carceral settings, recommends keeping a record of your symptoms to bring to your appointment, as well as a record of the medical care you’ve sought and received.
“If you can, document what you’re going through so you have a clear record of symptoms over time and what triggers them, when you told the doctor, and what interventions are offered,” said James.
Dr. Andrea Knittel, an obstetrician and gynecologist at the University of North Carolina who works with patients at a North Carolina women’s prison, recommends explicitly using the words “menopause” or “perimenopause” when talking to your provider and describing your symptoms “to flag for your clinician what you think is going on.”
Other conditions can cause symptoms similar to those caused by perimenopause, or aggravate perimenopause symptoms, including diabetes, thyroid problems and HIV. In some cases, a provider might reasonably try to treat another condition first to see if that eases your symptoms, but mentioning menopause and perimenopause puts your concerns on their radar and starts the conversation.
“It's reasonable to ask for a follow-up,” says Knittel. “If a provider says, ‘We need to get your diabetes under control before we know whether this is menopause or not,’ you can say ‘Okay, let's make changes to my diabetes medicine or my thyroid medicine, but then I’d really like you to schedule me for a follow-up, so that I don't have to pay for another sick call in order to get in if I still have hot flashes after we make these change.’”
It’s common to encounter providers who are not well-versed in perimenopause care, both in and out of prisons. If you get the sense your provider isn’t comfortable talking about this transition or isn’t knowledgeable, Knittel recommends saying “‘I would really like to see an OB-GYN or other women's health specialist.’” This will not guarantee you a visit with a specialist who is comfortable managing menopause, but Knittel says “it is at least a clear ask.”
While access to specialists and follow-up appointments can vary widely across different states and prisons, it is always worth asking, if you feel comfortable doing so.
Knittel also recommends being clear about how your symptoms are disrupting your life and ability to live in a communal setting. If working your job or sleeping have become difficult, tell your provider. Many currently and formerly incarcerated women who spoke to The Marshall Project described experiencing pushback or feeling dismissed by medical providers when they mention perimenopause or menopause. You may have to go back more than once to get the help you need, which can be frustrating.
“Advocate for yourself, respectfully,” said Linda Cayton, who was incarcerated in North Carolina. “Be persistent in asking for medical help, and ask for information about menopause from everyone you can think to ask within the medical unit.”
“Keep pressing forward with medical requests,” said Lori Pults, who is incarcerated in Missouri.
What specific kinds of medical relief can I request?
There are many different hormonal and non-hormonal treatments for perimenopause and menopause-related symptoms. Telling your provider that you want information about both kinds of treatments, and asking which options are available at your prison is a good starting place.
Hormone replacement therapy is a common treatment for perimenopause and menopause-related symptoms. This kind of treatment replaces the estrogen and progesterone that your body stops making, and can be administered in patches, pills or creams. For years, clinicians relied on research from the early 2000s that suggested HRT contributed to increased risk of cardiovascular issues, cancer and neurological side effects, so it was rarely recommended. But in 2025, the FDA removed “black box” warnings from prescribing HRT related to menopause, following additional research that revealed new findings about the benefits of HRT, and methodological flaws in the early 2000s analysis. Because of this history, some clinicians may still hesitate to prescribe HRT.
If you’re wondering what kind of HRT you might be able to get, James recommends asking a loved one on the outside to do some research to find out what is available in your state. Some correctional systems — including California, Oklahoma, Texas and the Federal Bureau of Prisons — make drug formulary lists publicly available. These lists include prescription and non-prescription medications that are available through the system's correctional health division, and may also specify what diagnosis or approvals are needed to access a specific drug. “That way you don’t have to waste your time asking for something that’s not available,” she said. While it is worth asking a loved one to check and see if they can find this information, not all states make these lists public, and they are less likely to be public in correctional systems that contract with private medical providers.
Even though the new research has shown HRT is safer and more beneficial than previously understood, it isn’t the right option for every patient. If your medical history includes breast or endometrial cancer, stroke, high risk of blood clotting or cardiovascular disease, it may not be the right choice for you.
Certain mental health medications are also commonly prescribed and can effectively treat perimenopause and menopause-related vasomotor symptoms like hot flashes and night sweats, including Effexor, Citalopram and Paxil.
“There is no medication that is necessarily the universal right answer,” says Knittel, but all of these options have been proven to reduce certain vasomotor symptoms. Knittel also emphasized that if your provider recommends a mental health medication and you are already taking an antidepressant that works for you, it’s okay to tell them that you are happy with what you’re currently taking and don’t want to experiment with a new medication.
What non-medical options for symptom relief could I request?
If you either don’t want to take HRT or other non-hormonal medications, or those options aren’t available to you, there are other ways to manage symptoms. James notes that “clinicians can be really powerful allies outside of what we consider medicine.” Some non-medical options your clinician might be able to write a note for include:
- Moving your bed closer to a fan
- An extra pajama shirt if you are sweating through your clothes at night
- Regular access to ice
- Relocation to a bunk with more shade if yours is in the sun
Knittel said she often writes such notes for her patients. These requests aren’t always granted, but you can ask for them.
You can also request increased access to menstrual products like pads and tampons, as bleeding can increase and become irregular during perimenopause. “Nobody should be expected to sleep in their bloody sheets, or wear their rinsed-out bloody underwear for an extended period of time, but those things happen all the time,” Knittel acknowledged.
Incarcerated people who spoke to The Marshall Project also described other options that helped them manage symptoms when prison staff are either unable or unwilling to provide adequate care.
“One thing I do to help with the hot flashes is keep a wet, cold rag in my bra,” said one News Inside reader in Arkansas. Remember to “wring it out good first!”
“In the hot summer months, I wet my nightgown, and squeeze it out, then put it on to stay cool,” said an incarcerated woman in New York. “Every three or four hours, I wet it again and do the same, but this is only if I don't have anywhere to go and I am staying in my cell.”
“One small thing that you can do is eat better and do meditation or yoga,” said another reader in Illinois.
Cayton, in North Carolina, also said it helped her to reduce caffeine intake. And if you’re feeling helpless, she said, “Just focus on the fact that it doesn't last forever….and at the end of it, you don’t have periods anymore.”
Talking to other women about what you’re going through can be incredibly helpful. Menopause and perimenopause can be stigmatized, but building community to commiserate and share tips is critical.
Knittel said it’s important to trust yourself, especially because these hormonal changes can at times make you feel crazy. “You know your body and your mind, and know when something is not usual for you.”
“Perimenopause and menopause are not shameful things,” added Knittel. “The more places that you can get information, the better, whether that’s through talking to your mom, or your auntie, or an older female partner, or your best friend. It’s really important to have those conversations for some social support.”
