In a Texas prison, Kwaneta cultivated a menopause support network from scraps of paper

She didn’t learn about much beyond hot flashes, night sweats and irregular periods in her nursing school training, or at any point during her decade-long career in the medical field. Her mom never passed along tips about that particular stage of life — just as her grandmother never shared any menopause wisdom with her mom.

This legacy of silence meant that Harris’ crash course in menopause came in her late 40s, while she was incarcerated at a Texas state prison. For three years, Harris experienced a litany of confusing ailments: shoulder pain, memory loss, heart palpitations, thinning hair and mood swings. She saw specialist after specialist, each visit costing $13.55 — a substantial amount for a person with no income — and typically requiring an hours-long bus ride to a medical facility in Galveston. None of these visits resolved the fears spiraling in her mind.

Harris finally connected the dots after hearing a neuroscientist explain on NPR that hot flashes, insomnia, memory lapses and anxiety are menopause symptoms, and they start in the brain, not the ovaries. “It was like clicking a puzzle again,” Harris told The 19th in a phone call from prison. “And it was so relieving because I really thought I was losing my mind.”

But when she brought this information to the prison medical staff, a familiar scenario began to play out, one that she characterized as a dismissal of her symptoms and no urgency to respond. She quickly understood that menopause care in prison — like other prison health care — is mired in a lack of resources and timely treatment options.

This reality set Harris on a hunt to find her own solutions, not only for herself but also for the growing population of incarcerated people experiencing menopause. Since 2022, Harris has built community with women in her facility, written articles for national news outlets and advised an organization on bringing menopause education to prisons. Her efforts are happening alongside a growing conversation among celebrities, politicians, journalists and the general public about the nuances of menopause.

Harris and other advocates recognize that menopause is having a moment, and they want to bring it to women and LGBTQ+ people behind bars.

“I try to tell women ‘This isn’t something that we have to suffer in silence about,’” Harris said. “Even though we don’t have as many means, it does help to know that you’re not suffering alone.”

Thousands of women over 50 are incarcerated throughout the United States. The percentage of women in this age group held in state and federal prisons grew from 8 percent in 2008 to 18 percent in 2023, according to data from the U.S. Bureau of Prisons.

Despite this rise, many correctional facilities do not appear to have policies that explicitly mention menopause care, according to a briefing published this month by the Prison Policy Initiative (PPI), a nonprofit public policy think tank.

In its analysis, PPI looked at publicly available prison policies and handbooks in all 50 states and Washington, D.C. Only five states have policies that contain specific information about menopause. In Alabama, for example, the state corrections’ healthcare services manual says that “preventative screening for osteoporosis, menstrual abnormalities, ovarian and cervical abnormalities, and menopause shall be provided.” It goes on to say that “inmates with abnormal results will be informed of their screening/test results and receive appropriate and timely follow-up testing and medical intervention.”

But, PPI notes, none of these policies “spell out what medical care, education, or resources prison officials provide to people experiencing perimenopause or menopause.”

In Texas, where Harris is incarcerated, there is no publicly available policy specifically guiding menopause care in the state’s prisons. In response to questions from The 19th, a spokesperson for the Texas Department of Criminal Justice said that the department has a “woman-to-woman peer education program that addresses common female health care topics to include some information on menopause.” She added that the University of Texas Medical Branch provides “all female health care services” for the state’s prisons.

The medical branch’s website states that for menopause, its specialists offer “advanced testing and personalized treatments — both hormonal and non-hormonal — to manage symptoms.” This includes care to both the general public and incarcerated people.

Still, Harris said she had to push the prison medical staff for two years before she received a prescription for Premarin, an estrogen medication also referred to as hormone replacement therapy (HRT), used to treat menopause symptoms. Every refill requires an additional fight; she has been waiting since 2024 for new HRT medication. She says she’s been told that if other women can endure the discomforts of menopause, she can too.

What does not help, Harris said, is that the prison gynecologists are typically older men who bristle with discomfort at the word “vagina,” making it challenging for her and others they treat to receive proper care.

There is little academic research examining the experiences of incarcerated women during menopause. What’s out there suggests that prison staff, including medical professionals, lack a comprehensive understanding of the ways this transition can present itself, or even how differently symptoms can look from one person to the next.

One survey distributed in 2022 to program directors at 145 obstetrics and gynecology residency programs found that 31 percent of the 99 respondents had a menopause curriculum.

“The doctors acted like you didn’t know what you were talking about,” one woman told researchers for a different 2022 study on incarcerated women’s experiences with menopause.

“They acted like you didn’t know your own body,” she said. If you’re not dying, they won’t do anything … with regards to menopause, they just say ‘you’ll get through it.’”

Harris and other incarcerated women have been trying to fill the gaps. On scraps of paper, or on a wall, Harris has drawn anatomical images to teach women at her prison about the reproductive system and what’s happening in their bodies. She has taken the nuggets of information from her doctors’ visits and things that have helped her own menopause symptoms and passed them on.

She recommends that the women in her prison stock up on pads and tampons because the hormonal changes of menopause can cause unusually heavy menstruation and large blood clots. In 2019, Texas started requiring prisons to provide unlimited access to menstrual products though limits in prisons nationwide are another source of frustration for incarcerated people.

If women her facility can, Harris has told them, they should keep a wet washcloth nearby for moments when they get overheated — a guarantee in a Texas heatwave.

“I would fill two bowls of water up, and I would sometimes put my feet in the bowl. I put my hand in the bowl, and I would meditate: ‘I am not in prison. I am on a beach,’” Harris said. “I would try to take myself there. It actually helped.”

As one woman learns helpful insights, she tells another, then another, creating a network of support and openness that combats years of stigma and misinformation about women’s reproductive and sexual health.

Harris said she and a few others once used a drawing pad purchased from the commissary to sketch bookmarks with information on menopause symptoms and then attempted to distribute them. Prison staff confiscated the bookmarks, she said. There’s a book about perimenopause and menopause that the women pass around in secret, and they hand off magazine clippings of information they come across.

“It’s more of a knowledge circle that we’ve created about how to cope and how to deal with this,” Harris said. “We have to teach each other. There is nobody else to teach us.”

Her reach is now growing outside her Texas prison. She regularly writes for news organizations and maintains a personal Substack page. In July, Harris collaborated with reporter Rebecca McCray on a guide to navigating perimenopause and menopause in prison. The Marshall Project published the guide on its website and as part of its “News Inside” publication, circulated to incarcerated people.

Harris is also on the advisory board for the Menopause Project, an initiative that launched in January with programming for incarcerated people at Central California Women’s Facility and the California Institution for Women.

The Menopause Project is an effort by the nonprofit organization Impact Justice, which focuses on reform in the criminal legal system. For this project, the group has worked with medical providers to design an easily digestible curriculum, including pamphlets and videos with information about perimenopause and menopause and how they can affect the body, said Aishatu Yusuf, vice president of innovation programs for Impact Justice.

The team held town halls that drew more than 600 incarcerated women between both facilities, and oversaw the coordination and development of training for prison medical staff to equip them to better recognize symptoms and provide care, Yusuf added.

Now, Impact Justice is working on expanding its Menopause Project to other states. In Texas, however, progress has been slower, Harris said. The menopause guide she helped create for incarcerated people has not been distributed inside her facility yet, she said.

Impact Justice contacted the Texas Department of Criminal Justice, but the status of those talks is still in the early stages. In response to The 19th, the department spokesperson acknowledged connecting with Impact Justice, adding that their office referred the organization to the University of Texas Medical Branch for further discussion.

The political landscape in Texas is much more conservative about sex and health education, something that affects people across the state, Harris said.

“They have an attitude such as, ‘This is part of your punishment.’ But this is not part of our punishment, to suffer,” Harris said. “So I think that education is a first step. I think that helps, letting women know inside that this isn’t something that we have to suffer in silence anymore about.”