A specialist visit from a Texas state prison costs $13.55 and an hours-long bus ride to a medical facility in Galveston. For three years in her late forties, Kwaneta Harris made that trip over and over — for shoulder pain, memory loss, heart palpitations, thinning hair and mood swings — and nobody connected any of it to anything. Thirteen dollars and fifty-five cents is not much money unless your income is zero, which a prisoner’s is; Harris kept paying it anyway, because the alternative was not knowing what was wrong.
The odd part is that she was the closest thing her prison had to an expert. She had been through nursing school and worked a decade in the medical field, and menopause had come up about as often as it did between her grandmother and her mother — hot flashes, night sweats, irregular periods, and otherwise silence. The diagnosis finally arrived by radio: a neuroscientist on NPR explaining that her seemingly unrelated symptoms were menopause, and that they start in the brain, not the ovaries. “It was like clicking a puzzle again,” Harris told The 19th, which reported her story, in a phone call from prison. “And it was so relieving because I really thought I was losing my mind.”
Armed with an explanation, she went to the prison medical staff and got what she describes as dismissal and no urgency. It took two years of pushing to get a prescription for Premarin, a standard estrogen treatment for menopause symptoms, and every refill has meant another fight; she says she has been waiting since 2024 for new hormone-replacement medication, and has been told that if other women can endure menopause, so can she. It doesn’t help, she says, that the prison gynecologists are typically older men who bristle with discomfort at the word “vagina.”
Harris’s cohort on the inside is growing fast. The share of women in state and federal prisons who are over 50 grew from 8 percent in 2008 to 18 percent in 2023, according to U.S. Bureau of Prisons data cited by The 19th. But a briefing published this month by the Prison Policy Initiative, which reviewed publicly available prison policies and handbooks in all 50 states and Washington, D.C., found only five states whose policies contain specific information about menopause. Alabama’s manual, for instance, says “preventative screening for osteoporosis, menstrual abnormalities, ovarian and cervical abnormalities, and menopause shall be provided,” with “appropriate and timely follow-up.” None of the five, PPI notes, “spell out what medical care, education, or resources prison officials provide” to people going through it.
Texas, where Harris is incarcerated, has no publicly available policy on menopause care at all. The Texas Department of Criminal Justice told The 19th it runs a “woman-to-woman peer education program that addresses common female health care topics to include some information on menopause,” and that the University of Texas Medical Branch provides “all female health care services” for the state’s prisons. UTMB’s website does indeed advertise “advanced testing and personalized treatments — both hormonal and non-hormonal” for menopause. The distance between that brochure and a two-year fight for a Premarin refill is where Harris has been living.
The knowledge gap is not exclusive to prisons. A 2022 survey of directors at 145 obstetrics and gynecology residency programs — the people training the next generation of gynecologists — found that 31 percent of the 99 respondents had any menopause curriculum at all. A separate 2022 study of incarcerated women’s experiences produced reviews like this one: “The doctors acted like you didn’t know what you were talking about,” one woman told researchers. “They acted like you didn’t know your own body. If you’re not dying, they won’t do anything … with regards to menopause, they just say ‘you’ll get through it.’”
So the women built the curriculum themselves. Since 2022, Harris has drawn anatomical diagrams on scraps of paper and on walls, passed along whatever she extracts from her own appointments, and dispensed practical advice: stock up on pads and tampons, because menopause can bring unusually heavy bleeding and large clots (Texas has required its prisons to provide unlimited menstrual products since 2019; much of the country hasn’t), and keep a wet washcloth within reach for overheating, which in a Texas heatwave is not a lifestyle tip but a coping mechanism.
Her own technique, she told The 19th: “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.’ I would try to take myself there. It actually helped.”
When Harris and a few others once used a drawing pad from the commissary to make bookmarks listing menopause symptoms and tried to hand them out, prison staff confiscated the bookmarks, she said. A book on perimenopause and menopause circulates among the women in secret, along with magazine clippings. “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.”
The circle has started reaching beyond the fence. Harris writes regularly for national news organizations and keeps a Substack; in July she collaborated with reporter Rebecca McCray on a guide to perimenopause and menopause in prison, which The Marshall Project published online and circulated to incarcerated readers through its “News Inside” publication; and she sits on the advisory board of the Menopause Project, an initiative launched in January with programming at Central California Women’s Facility and the California Institution for Women. All of it lands at a moment when menopause is finally getting a public conversation — Harris and fellow advocates want that conversation to reach people behind bars.
Her message to the women around her is that “this isn’t something that we have to suffer in silence about,” because “even though we don’t have as many means, it does help to know that you’re not suffering alone.” The state, for its part, describes menopause as a common female health care topic. What Texas has built around that topic is a peer-education program and, apparently, a confiscation policy for bookmarks. The rest is paper.