Menopause-related medication use among women age 45-75 experiencing incarceration in North Carolina 2015-2016

Abstract

Purpose This study aims to estimate the prevalence of individuals receiving hormone therapy for menopause management and the prevalence of underlying conditions that may constrain options for pharmacologic menopause management in the prison context. Design/methodology/approach This study reviewed all prescriptions dispensed by the North Carolina Department of Public Safety between July 1, 2015, and June 30, 2016, for relevance to menopause management. Relevant medications were those either recommended for menopause management or those indicated for management of conditions that may complicate menopause management, as per the 2015 clinical decision-support algorithm tool developed by the North American Menopause Society. Analysis was restricted to women between the ages of 45 and 75. Findings Of 1,120 women, a majority (77.8%) were between the ages of 45 and 54. Less than 5% of individuals in this study were prescribed estrogen-containing therapy. The most commonly prescribed medications that may constrain options for menopause treatment were related to hypertension and other cardiovascular disease or mental health conditions. Research limitations/implications The retrospective nature of this data set limits the findings, given that researchers did not have access to diagnoses or data on polypharmacy. Still, this study indicates that many women over 45 experiencing incarceration are living with health conditions that may complicate menopause symptom management with hormone therapy. Future research in carceral settings must examine the prevalence of menopause-related symptoms as well as access to and quality of comprehensive menopause management. Originality/value There is a paucity of literature around the menopause-related needs of individuals experiencing incarceration. To the best of the authors’ knowledge, no other research has examined prevalence of pharmacologic menopause management among women who are incarcerated.

A human rights assessment of menopausal women's access to age- and gender-sensitive nondiscriminatory health care in prison

“…The final data set (n = 16) consisted of a broad range of methodologies based on consultations, prison inspections, and prescribing/ chart data with qualitative studies using interviews with women in prison and healthcare providers (the United States, Brazil, Canada, New Zealand; n = 5) [39][40][41][42][43] ; mixed-method studies with women who experienced incarceration and healthcare providers (the United States, Canada; n = 3) [44][45][46] ; global reviews/opinion pieces (n = 2), 33,34 and US-based social legal reviews (n = 1) 35 and editorials (n = 3) [36][37][38] ; and secondary analysis of data (the United States, the United Kingdom; n = 2). 47,48 Environmental conditions and menopausal sequelae Despite the observed increases in numbers of older women in prisons globally, and although menopause was described as a unique and yet common health issue within the detention space, documentation around detention conditions experienced during menopause in prison remains underexplored. 33,34,[39][40][41]45,46 The assessment reveals a violation of Bangkok Rule 5; "accommodation of women prisoners shall have facilities and materials required to meet women's specific hygiene needs, including sanitary towels provided free of charge."…”

“…So, I never went back to medical for it [menopause].” Transport logistics impeding access tertiary care was reported by prison health professionals in one US study 39 . A secondary analysis of dispensing data in the United States documented women's lack of access to hormone therapy, with less than 15% of women in prison prescribed any kind of menopausal management and only 3.6% of menopausal women in prison who received estrogen therapy 47 . “Patient Care” in New York provides hormone medication for imprisoned menopausal women to manipulate menstrual irregularity 35 …”

“…This opportunity should also be seized for imprisoned women where the health gains are likely to be even greater for the individual. Further research with both imprisoned women and prison staff (both health care and custodial) is warranted to raise awareness and to inform evidence-based policies and practices to improve quality of life of older women in prison 33,39,47 …”

Menopause for justice-involved women: consequences and care in prison systems

“…In this group, fewer than 5% of individuals were treated with estrogen-containing therapy. 14 All justice-involved individuals face loss, loneliness, and the lack of social comfort from family and friends as they age. They face increasing symptoms of illness and disability in an environment where healthcare may be suboptimal.…”

“…In a focused study of the North Carolina Department of Public Safety, 77.8% of 1,120 justice-involved women were between the ages of 45 and 54 years. In this group, fewer than 5% of individuals were treated with estrogen-containing therapy 14 …”