What It’s Like to Go Through Perimenopause and Menopause in Prison

Limited information and a lack of informed health care providers make this life transition even more difficult for incarcerated people.

By Rebecca McCray
The Marshal Project
https://www.themarshallproject.org/

Kwaneta Harris suddenly developed intense shoulder pain in 2019. Incarcerated in Texas, she began the process of requesting a specialized medical visit, certain she needed to see an orthopedist. Then, she started having heart palpitations and tachycardia, an abnormally fast resting heart rate, and requested a visit to the cardiologist. Around the same time, acne broke out across her face, something she’d never dealt with, even as a teenager. She filed a request for a dermatologist. Once a calm and collected figure on her cell block, she began to cry easily, and struggled to recall details and words that previously felt ingrained. Her long, dark hair began to thin.

Harris, a former nurse who is now 53, was quick to self-diagnose. Assuming she had a thyroid problem, she requested a visit to an endocrinologist. Getting each specialty visit took months. First, she had to exhaust any recommendations from the in-prison medical provider, a process that often took three or more months. When those remedies failed, she could request a second opinion, after which she’d wait two to three more months to get approved. Each specialty visit then required an hours-long trip across the state to Galveston on a bus, shackled to another woman. None of these appointments brought relief.

Three years after the shoulder pain began, Harris was listening to NPR when a TED Talk about perimenopause came on. Suddenly, the constellation of medical symptoms all made sense.

“She said the most magical words I’ve ever heard, and I felt so much better: ‘You are not crazy,’” said Harris. “I remember saying ‘thank you’ out loud.”

But even once she knew the origin of her symptoms, Harris says medical providers continued to dismiss her. It took two more years for her to get a prescription for Premarin, a hormone replacement therapy (HRT). A provider agreed to prescribe a 60-day trial supply after Harris pleaded for relief, in tears. The prescription was never refilled when it ran out.

Harris’ Kafkaesque journey isn’t unusual for perimenopausal and menopausal people in prison, where access to information about this life transition is scarce. Menopause is diagnosed after someone has gone without a period for 12 months. Perimenopause is the months- to years-long transitional period leading up to this cessation. Social media is crammed with celebrities sharing their experiences and influencers giving tips for managing symptoms or singing the praises of HRT. But that wave of advice and resources hasn’t reached most carceral settings.

Many incarcerated people approaching menopause are left to navigate these seismic physical shifts on their own, self-diagnosing and advising each other. For some, the lack of information and knowledge about menopause makes it difficult to even name what they’re experiencing. Makeshift tools and tricks cobbled together to manage symptoms can trigger disciplinary action. Requesting menopause-related medical care in a system that often fails to provide the bare minimum can be a frustrating and ultimately fruitless process. While new networks of care are emerging, offering hope in some prisons, these advances remain inaccessible in many places.

Lori Pults, 52, remembers laying on her bunkbed, working on a prison ministry course on her tablet, when she was suddenly overcome by heat. She mistook her first hot flash for a fever.

“It starts in your chest, and you just have this overwhelming feeling, like you stepped under a spotlight,” Pults said.

Pults, who is serving a life sentence in Missouri, lost her mother when she was young and was raised by a grandmother who never told her about menopause. Fortunately, a nurse practitioner at the prison explained it to her.

But Pults’ relative ease in finding a medical provider well-versed in menopause is highly unusual in prison health care, and literature on the subject is hard to come by. Prisons sharply restrict access to news and information, wielding censorship as a tool for maintaining security. Libraries often have scant resources and unreliable hours, and doing basic online research is virtually impossible. Resources sent by mail, including medical reference books, are sometimes banned, misconstrued as pornographic. All of these barriers can make it challenging, if not impossible, for people behind bars to learn about menopause.

“There is no information whatsoever available for women on this topic,” said Ann, who is serving a life sentence at Bedford Hills Correctional Facility in New York. (Because of the high-profile nature of her case, she asked that we use only her middle name.) “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.”

Thomas Mailey, director of public information for the New York State Department of Corrections and Community Supervision, said that there is a full-time gynecologist on staff at Bedford Hills available to answer questions on “all women’s health care related subjects.”

There has long been a dearth of research on menopause, and even less on how it plays out in prisons. Dr. Andrea Knittel, an obstetrician and gynecologist at the University of North Carolina, published a first-of-its-kind qualitative study in 2025 with a group of researchers examining how menopause symptoms “shape experiences of the criminal legal system.” It’s the largest study of this intersection of issues to date, and one of fewer than 10 peer-reviewed studies touching on menopause in prisons. The lack of information available to incarcerated women, and their subsequent confusion, was a recurring theme in Knittel’s research.