By Kwaneta Harris
From PHN Issue 58, Fall 2024
What Are Menopause and Perimenopause?
Menopause = Meno (monthly period) + Pause (stop). Menopause is
the end of having a menstrual cycle. Technically, it is twelve months without
having a menstrual period. Perimenopause leads to menopause. It is when a person with ovaries is in their final reproductive years. Symptoms of menopause can begin during perimenopause and continue for up to a decade. Despite the name, the journey to menopause is not just about our period stopping. Some people don’t have periods due to a hysterectomy or infertility. It’s easier to think of menopause as a time of reduced hormone production.
Hormones play a vital role in our quality of life. Perimenopause begins with our ovaries producing decreased levels of the hormones progesterone, testosterone, and estrogen. This means these hormones are NOT getting into our bloodstream and NOT traveling to cells all over our bodies. We have cells that respond to these hormones in every single part of our body—our brains, lungs, bladder, muscles, bones, everywhere—and their decreased production can cause symptoms in all these systems.
Menopause Is Not an “Old Lady Problem”
Typically, people in high-income countries experience perimenopause during their early 40s. On average, they experience menopause at age 51.
Incarcerated people don’t have to wait as long. Because the conditions of confinement accelerate the physiological age of prisoners beyond their numerical age, the National Commission on Correctional Healthcare defines “elderly” as any prisoner over 50, rather than 65.
Early perimenopause can begin at 30 and some people still experience symptoms at 60.
Menopause Is Not Monolithic
Everyone reacts to hormones differently. Just like how period cramps can be mild, severe, or nonexistent for different people, perimenopause experiences are specific to every person. Some individuals have symptoms like acne, dry skin, weight gain, headaches, joint pain, and difficulty
sleeping. Others have more severe symptoms like brain fog, fatigue, poor sleep, urinary tract infections (UTIs), anxiety, heart palpitations, vaginal dryness, painful sex, heavy and irregular
menstrual bleeding, stabbing menstrual cramps, depressed (low) mood, and dry eyes.
As a person transitions from their late reproductive years to early perimenopause, hormone levels
fluctuate daily. Because a hormone panel blood test is only a snapshot of the moment the test was taken, no diagnostic blood test exists. A menopause-informed practitioner will diagnose perimenopause according to a person’s symptoms.
The cliché symptoms are hot flashes and night sweats. Waking up to drenched sheets becomes the norm. Black women have been found to experience more hot flashes than white women.
Perimenopause and menopause are also worse for women of color. They also endure them the longest, according to several studies, including the Study of Women’s Health Across the Nation
(SWAN) studies conducted at the University of Pittsburgh. More than half of women in prison and more than two thirds of women in jail are women of color.
Hormones Help Prevent Disease
The hormones estrogen, progesterone and testosterone have anti-inflammatory
properties and help our immune systems work well. The longer a person goes without these hormones, the greater their risk for inflammatory conditions like cardiovascular disease, the most common cause of death in people assigned female at birth. Inadequate hormone levels during perimenopause and menopause also contribute to irritable bowel syndrome (IBS), arthritis, diabetes, Parkinson’s, and osteoporosis.
Treatment
Studies are mixed on whether natural alternatives like black cohosh, soy treatment, and clover supplements are effective in relieving symptoms related to menopause. Studies into the effect of
vaginal laser rejuvenation for menopausal symptoms are also inconsistent. Researchers recommend caution and more rigorous research. The FDA has warned that vaginal laser treatments can cause serious complications.
Cognitive behavioral therapy (CBT) and meditation, however, can help relieve symptoms. The medication Paroxetine, a selective serotonin reuptake inhibitor (SSRI), also offers relief from hot flashes. The birth control transdermal patch, intrauterine devices (IUD), vaginal hormonal cream, and other types of hormone replacement therapy (HRT) can decrease menopause symptoms. Due
to a flawed study in the early 2000s, HRT has gotten a bad rap. However, nothing is without risk and determining if you are a good candidate for HRT involves having a nuanced conversation with your doctor. Generally, hormone replacement therapy is more risky for people experiencing undiagnosed vaginal bleeding, have active cancer, severe liver disease, or an active blood clot. Personally, HRT has helped alleviate my perimenopause symptoms. My memory is better, my
hot flashes have stopped, my skin isn’t dry, and I don’t cry at the drop of a dime. However, my relief didn’t come easily. It was a four-year battle against gaslighting. When I became tired, my
friends advocated on my behalf.
Self Advocacy in Prison
Prison is not considerate of the needs of individuals experiencing menopause. When you are categorically dismissed and your medical requests are ignored, it’s time to file a grievance and seek a second opinion with an endocrinologist or a gynecologist.
Many medical providers haven’t been trained in menopausal care. If you face the standard gaslighting response of “this is natural, just deal with it,” remember that you are an expert in
your body and can demand to be an active participant in decision-making about your life.
I also highly recommend requesting a bed or work station with window access, requesting a medical pass, keeping a washcloth with you at all times, keeping a log to document all activities during your hot flashes, and presenting that log to your medical provider.
If you’re simultaneously complaining of fatigue, heart palpitations, acne, joint pain, and depression, and your primary care physician (PCP) refers you to an endocrinologist, a cardiologist, a dermatologist, an orthopedist, and a psychiatrist, you might consider doing a trial of hormone therapy to see if your symptoms get better before practitioners begin playing whack-a-mole in treating each symptom.
Establish a Support Group
Destigmatize menopause by asking others about their experiences with it. Find out what worked and what didn’t work for them. Share knowledge and experiences in a judgment-free zone and
remind each other that menopause is a big deal. It’s not simply about reproductive care, but a whole body issue. Your body is experiencing hormonal chaos. This is the most significant biological change of your life and you shouldn’t have to suffer in silence. ✦
Prison Health News 