Prisoners Going Through Menopause Get 'Double Punishment'

By Ronnie Cohen

June 23, 2021

(Reuters Health) - For a growing population of aging incarcerated women, the transition to menopause can be especially fraught yet largely overlooked by prison healthcare systems, a new review shows.

"Folks who are incarcerated are more likely to have chronic medical conditions as well as mental health conditions that mean that managing menopause for them is more complicated," said Dr. Andrea Knittel, medical director for Incarcerated Women's Health at the University of North Carolina in Chapel Hill, who was not involved with the study.

At the same time, incarcerated women are less likely to receive education, healthcare services, medications and supplies as basic to menopause and perimenopause as a sufficient supply of sanitary pads, the research team wrote in Maturitas.

Knittel described herself in a phone interview as one of just a handful of obstetricians and gynecologists across the U.S. working in women's prisons.

The review article points out that incarcerated women might not know why they are having hot flashes, and they probably lack access to fans, air conditioning and the ability to change sweat-soaked clothing and bedding.

The researchers looked at 39 studies on menopause in women behind bars. The number of women incarcerated in the U.S. multiplied nearly nine-fold in the past four decades - from 26,378 in 1980 to 222,455 by 2019, they write. Older women are among the fastest growing segment of the prison population.

"All literature points to the notion that living in a prison system is a 'double punishment' especially for aging women as they must endure both challenges that accompany incarceration and the distressing symptoms of menopause and aging," the authors write.

The review highlighted how little is known about the effect of incarceration on menopausal symptoms, Knittel said. "We don't have any data to tell us what is happening to women across the country," she said.

Knittel has overseen prior research that included interviews with imprisoned women going through menopause. Some of them mistook menopausal symptoms for drug withdrawal or side effects of medications, she said. When some sought relief from menopausal symptoms, healthcare practitioners regarded them as drug seekers.

When menopause was explained to symptomatic incarcerated women, they were surprised and relieved to learn they were going through a normal life transition.

No known programs for incarcerated women transitioning into menopause exist, the reviewers found.

Obesity, a risk factor for vasomotor menopausal symptoms, is common in incarcerated women, with up to 43% considered obese, the review says. Poor nutrition and lack of exercise while imprisoned can lead to weight gain. Prison meals usually consist of salty, processed food and limited fruits and vegetables - a diet that can exacerbate menopausal symptoms.

Incarcerated women also have higher rates of mental illness than women in the community or incarcerated men, the study found. Menopause can trigger emotional issues.

"For women who are incarcerated there are additional challenges. We need to be aware of the challenges, address them by education and by offering services," said Dr. Gloria Bachmann, one of the study's authors, chair of the New Jersey Commission on Women's Reentry Health Committee and director of the Women's Health Institute at Rutgers Medical School.

"Obviously, the education is key," she told Reuters Health in a phone interview.

Lifestyle changes, such as sleeping in a cool room, that Knittel said she might recommend to free women to ease menopausal symptoms tend to be restricted or impossible to implement in prisons and jails, she said.

The vast majority of incarcerated women have experienced physical or sexual trauma, she said. "It's going to be important to explore how their trauma histories will influence the kinds of treatment they want and the ways they engage with the medical system," she said.

"Just as in society, within jail and prison facilities, menopause is often seen as just something to get through," Knittel said. "While it is certainly a normal life transition, the symptoms of menopause can be really distressing, and addressing that both from a medical and psychosocial perspective is really important. And that can be hard in a prison or jail setting."

SOURCE: https://bit.ly/3iGG5WL Maturitas, May 31, 2021.

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