Early January 2020. It was time for the after dinner “count” of prisoners in the Lowell Women's Correctional Facility Work Camp, just inside the “city” limits of Ocala, Florida. Victoria stood outside the door of her prison cell waiting for one of the guards to stroll by and shout her name at top volume to indicate she was present when a wave of what she thought was hot air rushed from her feet up to her head, causing her to break into a sweat that ran down her face and into her eyes.
The prisoners were not allowed to move at all during count so Victoria knew that she could not wipe her brow. Not knowing which guard was making the long walk around the pod, she did not want to take any chances. About a month earlier, one woman had actually fainted while waiting for “count” to be completed. She was isolated to solitary confinement, and had not been seen since.
Victoria, a 45 year old black female manager of a Central Florida Caribbean hair salon, had arrived at Lowell in October of 2019 after a 4 month “layover” in the Florida Women's Reception Center, where the Florida prison administration followed some sort of unclear classification process to determine where to place Victoria for the next six years of her prison sentence.
In 2018, Victoria had been stopped for a broken tail light while driving her son's car to work. Police, during a subsequent search of the vehicle, which Victoria had consented to, discovered in the trunk 2 small glassine bags of meth, 3 ounces of homegrown marijuana, 30 capsules of MDMA and a nearly 30 year old non working shotgun that had belonged to her great grandmother. Victorias knew that her 28 year old son, who had suffered from chronic depression his entire life and was the eldest of 4 children, was a pot smoker, but she could not imagine him as a drug dealer. Nevertheless, Victoria had been arrested on the spot, charged with drug trafficking and possession of a firearm during the commission of a felony, the felony being she was driving with a broken taillight while transporting large quantities of drugs. Her bond was set too high for her family to pay and she had received a termination letter from her employer while she was being held in the local county jail awaiting her neverending court dates. Some “plea deals' had taken place between the prosecutor's office and the public defender who was representing Victoria, and she had been eventually sentenced to 6 years in prison and 4 years of subsequent probation. Victoria's sentence had been especially harsh because she had three previous arrests for prostitution. All of the prostitution arrests were almost 20 years old. She had been convicted while she was a young mother trying to feed her family. The State of Florida, however, considers a third conviction of misdemeanor prostitution a felony with a mandatory sentence of 1 year in prison. It was this permanent felony record, more than 2 decades before the traffic stop, that landed Victoria in prison.
The Lowell Women's Prison did not have working air conditioning in that part of the overcrowded prison, and all of the ladies in Victoria's prison pod had warned her to “get ready” for some really miserable conditions. As the sweat poured down her face, neck and back, Victoria assumed that the dreaded summer had started. The following 2 years at Lowell, where conditions were notoriously bad, only got worse. As the Covid 19 Pandemic ensued, the female prisoners at Lowell suffered through months of confinement with broken sewer systems, food shortages, and cassation of mail deliveries and visitation from family and friends. Victoria was unable to seek advice from fellow prisoners in these early stages, and her night sweats, mood swings and panic attacks were all attributed to Covid 19. Victoria;s 28 ear old son, the driving force behind her incarceration, committed suicide shortly after her arrest in 2019.
What is Menopause?
Menopause, the cessation of menstruation marking the end of a woman's reproductive years, typically occurs between the ages of 45 and 55, but perimenopause can start as early as mid to late 30’s for some women. This transition is often accompanied by various symptoms, including hot flashes, night sweats, mood swings, urinary frequency and urinary tract infections (UTIs), along with increased risk for osteoporosis and cardiovascular diseases. Incarcerated women experience menopause within the harsh constraints of prison environments, which exacerbates their symptoms and complicates their management.
Women who are born with a vulva spend ⅓ of their life in the throes of menopause but almost everyone we talked to for this post spent at least 10 years suffering from the symptoms without any kind of relief. For some, menopause can be a process that lasts for more than 20 years. The transition into menopause is an inevitable part of life and the normal aging process. For many, it’s accompanied by a range of symptoms including hot flashes, insomnia, brain fog, fatigue, irritability and weight gain. Yet menopause continues to be under-studied and undertreated with just one in five OBGYN residents having any training in the complications of symptoms. Menopause, and the symptoms from menopause, are also highly stigmatized. If you look up Google images of menopause, you see harried hot, sweaty, angry women.
How is Menopause Treated in Prison?
A 2016 study highlights that incarcerated women often enter prison with poor health profiles, including higher rates of chronic conditions that can exacerbate menopausal symptoms. The prison environment, characterized by high stress, inadequate nutrition, and limited access to health care, can worsen these symptoms and accelerate the onset of menopause . Moreover, research also indicates that prisons are ill-equipped to address the specific health needs of menopausal women. The lack of gynecological care and hormone replacement therapy (HRT) means that many women suffer needlessly from untreated menopausal symptoms. This neglect can lead to severe physical and psychological consequences, further diminishing their quality of life during and after incarceration. These disparities also lead to diminished overall quality of life and mental health, which actually costs the prisons more in response to both physical and behavioral problems.
Victoria's early symptoms of menopause were anecdotally misdiagnosed by a new prison guard, frantically hired and inadequately trained after a mass exodus of corrections officers, as Covid 19 and she was sent to solitary confinement in March of 2020. Not to medically test or treat either Covid or Menopause, but to keep her isolated from corrections officers and other prisoners. She was never tested for Covid 19 while being held in solitary confinement for the next 9 months. Her menopausal symptoms continued to be interpreted as Covid to the untrained corrections staff even as she begged repeatedly to see a medical professional. The corrections officers often forgot to bring meals to the other women being held in solitary and after the sewer backed up into nearly all of the pods in the prison, the corrections officers refused to even enter the pods for any reason. There was no outside recreation, no exercise, no books or magazines, no mail from loved ones and no socializing with the other women. Like many women, Victoria didn’t know anything about menopause and her physical and mental health disintegrated quickly under these harsh conditions. Victoria, always a healthy and physically active woman before her incarceration, contracted pneumonia that winter and encephalitis the following spring. She was never tested, diagnosed or treated for any of the symptoms she endured. When finally she was granted a compassionate release in January of 2024, her family barely recognized the shell of the mother they had loved. Weighing just 85 pounds on release, Victoria had pulled large patches of her hair out from trichotillomania, which she had developed during the long months of solitary confinement, and she suffered from a chronic dry cough. Victoria frequently forgot where she was, how she got there and what she was doing.
Sexual Health in Incarcerated Women
Sexual health covers STI prevention and treatment, reproductive health, and the psychological aspects of sexuality. Incarcerated women face unique challenges in maintaining sexual health due to stigma, trauma, and the high-risk environment of prisons. They are at a higher risk for STIs due to factors like drug use, high-risk sexual behaviors, untreated urinary tract infections, dehydration in the overcrowded prisons, and poor living conditions. While STI rates among incarcerated women are lower than men, they are significantly higher than the general population, with chlamydia, gonorrhea, HPV, and HIV being particularly prevalent. These infections often go undiagnosed and untreated due to limited healthcare access. However, these bacterial infections are easily diagnosable and curable with inexpensive tests and antibiotics. Similarly, hormone replacement therapies are relatively cheap and often result in improved mood and reduced anxiety.
This is a very “fixable” problem and not doing anything about it has long lasting impacts both physical and mental well-being of incarcerated women, and the prison staff interacting with them.
Despite major gains in mental health awareness, "The Change" is still stigmatized and often met with silence — with vague euphemisms about menopause a case in point. That is due, in part, to a toxic combination of ageism and reticence about overall women's sexuality. In the United States, billions of dollars are spent on anti-aging products per year, so the idea of embracing aging and the natural process of getting older goes against society norms. In addition, women who are perimenopausal or in menopause may have challenges in their sex lives, and that is another topic that is not often spoken about or embraced openly, especially for women. Women in menopause are kind of erased everywhere. When menopause is discussed in Western society, it's often viewed negatively, as a cruel joke or even as a disease.
Victoria's youngest daughter took her to the family obstetrician shortly after her release and the physician, knowing Victoria both before and after her incarceration ordered a myriad of blood tests to diagnose various infections and disorders as well as the long term impacts of untreated Hepatitis A, most likely contracted from extended exposure to the sewage overflow at the prison, and quickly discovered that Victoria’s hormones were indicative of a particularly difficult menopause experience. She started Victoria on a long course of antibiotics and hormone replacement therapy and Victoria's health started to improve. Slowly at first, but as the anti-biotics fought off the infections, and the hormone replacement therapies reduced her hot flashes and night sweats, Victoria started to regain weight, her hair started to grow back and she became the delightful personality that friends and coworkers remembered within the first few months. By April of 2024, Victoria was no longer experiencing the relentless coughing and she returned to work at the hair salon, where her clients and coworkers welcomed her back with open and loving arms.
Menopausal Health Care Interventions
Improving treatment for menopause in incarcerated women requires a comprehensive approach that integrates medical care, education, and policy reform. Firstly, enhancing access to medical care is crucial; this includes regular screenings, specialized training for healthcare providers, and ensuring the availability of gynecologists to address menopause-specific issues. Providing appropriate medications, such as hormone replacement therapy (HRT) and non-hormonal treatments, alongside symptom management strategies, is essential. Education plays a key role, with health education programs and support groups helping women understand and cope with menopause. Improving living conditions by ensuring proper climate control, offering nutritious diets, and facilitating physical activity can significantly alleviate symptoms. Policy development and advocacy are also vital, pushing for policies that recognize the unique health needs of menopausal women in prison and conducting research to guide effective interventions. Lastly, individualized care plans and continuous monitoring ensure that treatments are tailored to each woman’s specific needs and adjusted as necessary. Together, these measures can lead to significant improvements in the quality of life for incarcerated women experiencing menopause.
The intersection of incarceration, menopause, and sexual health presents a complex set of challenges that require urgent attention and intervention. By understanding and addressing the specific health needs of incarcerated women, particularly in relation to menopause and sexual health, we can improve their health outcomes, reduce disparities, and promote a more humane and effective correctional health care system.
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If you are suffering from the symptoms of menopause, there are resources you can go to and then speak to your Doctor about the various hormone replacement therapies that best meet your needs.
RedHot Mamas Online Support Group - Join the conversation with others
Menopause and Me - Experts answer questions about menopause, FAQ’s and educational Information
Menopause - Lets Talk About It - Questions to ask you physician when talking about your menopause experience
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