(Poster 171) Menopause Symptoms Among Women with Criminal Legal System Involvement

Objectives: The number of women and older adults involved in the criminal legal system is increasing. Even with a progressively older female population, there remains limited information about the experience of menopause among women with criminal legal system involvement. Our aim was to describe menopausal symptom burden during and after incarceration of a large and diverse group of women with a history of criminal legal system involvement.

Methods: This mixed methods study included quantitative survey data and qualitative semi-structured interviews. Quantitative data were collected from a survey of adult women in the community in three US cities with a history of criminal legal system involvement including jail, prison, probation, and parole. Menopausal symptoms were evaluated using the Menopause Rating Scale with a yes/no indicator for each symptom and a severity rating of mild (1), moderate (2), severe (3), or very severe (4). A separate qualitative sample of data on menopause experiences in the community were elicited during semi-structured interviews with adult women from five states across the US who experienced menopause during their criminal legal system involvement.

Results: In 508 women surveyed, the mean age was 46 and 349 (69%) completed menstruation and menopause questions. Pre- (monthly menses, n=151), early peri- (every 1-2 month menses, n=25), late peri- (gaps in menses of 8 weeks or more, n=10), and post-menopausal (no menses in 12 months, n=163) women reported bladder problems at a rate of 26% (n=40), 39% (n=9), 30% (n=3), and 39% (n=64) respectively. Bladder problems included symptoms such as difficulty urinating, urinary frequency, and incontinence. The average severity in all groups was moderate (range 1.82-2.33 out of 4). These women also identified sexual problems such as change in sexual desire, activity, and satisfaction (pre- 27% n=41, early peri- 22% n=5, late peri- 40% n=4, post- 35% n=57) as moderate to severely bothersome (range 2.17-2.25 out of 4) and vaginal dryness (pre- 15% n=22, early peri- 9% n=2, late peri- 20% n=2, post- 20% n=33) as mild to moderately bothersome (range 1.5-2.0 out of 4).
In a separate qualitative analysis, semi-structured interviews were conducted with 29 women (mean age 57). The major qualitative themes described barriers to accessing menopause care in the community, including lack of established provider, insurance/financial, transportation, discomfort discussing menopause, and providers’ lack of knowledge surrounding menopause.

Conclusions: Women with a history of criminal legal system involvement commonly experience genitourinary menopausal symptoms, including bladder, vaginal, and sexual problems . Many report that menopausal symptoms are bothersome, and for some, symptoms are highly bothersome. At the same time, these women experience multiple and unique barriers to access subspecialty care for genitourinary symptoms of menopause. Further research is needed to elucidate the best ways to improve care for this population.