Menopause and Renewal
“The Change” comes with obstacles and opportunities
It may be winter here at Central California Women’s Facility (CCWF) with frost on the main yard. However, for a few residents it is summertime all year round. For them, menopause has taken effect, and the change is real.
The National Institute on Aging describes menopause as “the stage of a woman’s life when her menstrual periods stop permanently, and she can no longer get pregnant.” This life stage starts between the ages of 45 and 55, and can take several years. During this time, a woman’s body produces less and less estrogen and progesterone, two hormones made by the ovaries.
The institute is careful to point out that it is not a disease (though some people view it that way). Medical doctors will offer women a biological description of menopause that comes with a host of physical changes. Others may look to the cultural understanding of what it means to be a “woman of a certain age,” with all the existential discourse that comes with it. Not only is the loss of fertility an important biomarker, but the increased risk for midlife problems is exasperating to most.
It is true — there should be a personalized manual for this life stage. This is because menopause brings varied symptoms and the timing is unmanageable. The top physical menopausal symptoms stemming from hormonal changes are night sweats and hot flashes. But there are many others: insomnia, fatigue, bone and joint pain, sexual dysfunction and emotional instability. Cycling through the numerous pitfalls associated with menopause can make the days slow and without meaning.
Women worldwide would love there to be a “one size fits all” remedy. The closest we have right now are menopausal hormone treatments (mHT). One such treatment is estradiol. According to a 2024 article published by Climacteric, the peer-reviewed journal of the International Menopause Society, estradiol taken in transdermal patch or pill form are effective treatments for menopausal symptoms “with little difference in treatment efficacy and safety.”
But the imbalance of hormones and the treatments available do not always fit. From what we’ve seen at CCWF, just like menopausal women, the use of mHT can run hot or cold. It either works or it doesn’t.
When we finally got to talking about this difficult topic, CCWF residents had much to share.
“I take Prempro for hot flashes and night sweats. Without it, my legs will sweat, And my face gets beet red. Who needs that?” Holly Ramos, 51, told me.
Ramos relayed what many women here know: immense stress is a leading cause of early onset menopause. “So,” she said, “at 40 I just stopped menstruating. By the time I was 45, I was in the throes of menopause when [CCWF OB/ GYN] Dr. Graves suggested Prempro and I’ve been on it ever since.”
Prempro is a hormone replacement therapy (HRT) used by millions of women for the relief of menopausal symptoms.
It can’t be said strongly enough that the conditions of incarceration make treating menopausal symptoms even more difficult. This important point was made in Menopause: The Journal of the North American Menopause Society, in a 2021 article called “Experiences of Menopause During Incarceration.”
“Understanding menopause experiences among women who are incarcerated,” the authors write, “is a critical step in identifying gaps in access to and quality of care for the underserved and growing population of older women in prisons and jails.” According to the California Department of Corrections and Rehabilitation (CDCR) most recent COMPSTAT DAI Statistical Report, from 2023, the total number of women of menopausal age in CDCR custody 1,448. That’s approximately 50% of the total biologically female prison population.
The experience of CCWF resident Donna Lee, 73, makes this point clear.
“When my menopause was at its worst,” Lee said, “I couldn’t strip down fast enough. However, I had to program all day and go to chow. I had a wash cloth to hit all my hot spots (face, neck, arms and feet). I was probably cranky as well. I had to push for some medication I saw on TV [Estroven, a food supple-ment for menopausal symptoms], but they only gave it to me for a month and then refused my requests to refill. I finally just gave up trying.”
Another difficulty during menopause while incarcerated is the lack of sanitary supplies to support the changing body, like sanitary pads, replacement underwear, and clean bedding. Although CCWF is a women’s facility, there is a never-ending need for sanitary products. It adds an extra layer of stress for women trying to care for their very private needs, not to mention the overall difficulty of striving for “normalcy” within the razor wires.
Since menopause stems from declining production of certain hormones, it is easy for people to wrongly correlate menopause with deficiency within the woman’s body. This explanation runs in line with the information many receive through their doctor. “It’s just what happens,” “There is nothing that can be done” and the list goes on.
This is a hard thing to hear and takes a psychological toll. This is when our minds start racing with the “forever young” discourse, which challenges the mind of any woman who doesn’t want to appear her age. The waiting game for moisturizers to fix that wrinkle or that saggy eyelid can drown out the truth: We all age and we need to accept that.
More helpful is an existential thought process about menopause that brings acceptance and that focuses on the many possibilities that exist in the future of an aging woman. These include the right to believe in one’s own freedoms and how to carry those out with confidence. A woman going through the “change” can still have many adventures on the horizon that bring wisdom, strength and hope to those who follow. This is where the positivity of being “grown” makes its rounds through the newness called menopause and life gets good. Self-discovery and challenging oneself to be the best version, no matter what, will confront the lie that menopause is “death to the soul.”
Until there is sufficient knowledge of mHT’s, HRTs, and their true ability to eradicate menopausal distress, women will continue to prepare themselves mentally and emotionally for the physical journey. Women around the world will continue to hope for the best while sweating it out during the night.
