Menopause and the prison: A Systematic review exploring the experiences and support needs of women in prison in relation to the menopause

The convergence of an ageing prison population and increasing numbers of women held in custody globally has resulted in a growing sub-population of women of menopausal age experiencing imprisonment. 1 – 6 In the United Kingdom, the number of women in custody aged 50 and over rose from 178 in 2002 to 540 in 2020, despite the overall female prison population reducing by 18% during this time. 7 In the United States, the number of women in custody over the age of 45 more than doubled between 1999 and 2019 to 25,337. 2 , 4 Aday and Farney 8 found that in a study of 327 women in prison in the United States aged 50–77 years, 30% identified as experiencing menopause symptoms. A health needs analysis in Iran with 434 female prisoners of all ages identified 13.4% of participants as being menopausal. 9 Similarly, in France, a quality-of-life questionnaire used with women in prison aged 25–65 identified 14% of women as menopausal. 10 In addition, Hatters-Friedman et al. 11 found that in the United States, problems related to menopause were the third most common health concern reported for older women in prison. Biopsychosocial approaches suggest hormonal changes associated with menopause can elicit physical symptoms including disturbances in sleep and libido; vasomotor symptoms such as hot flushes and night sweats 2 , 12 and psychosocial symptoms including anxiety, depression, difficulties concentrating and irritability. 11 , 13 In addition, most of these menopausal symptoms can be exacerbated by the prison environment. 5 , 14 , 15 There are various non-binding ‘soft laws’ that recognise the health and gender-specific needs and rights of women in criminal justice systems, 16 including the UN Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (the Bangkok Rules); the UN Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules) and the UN Standard Minimum Rules for Non-custodial Measures (the Tokyo Rules). However, Van Hout et al. 17 noted variable adoption of the rules globally, and research highlights that women in prison around the world continue to have their fundamental rights deprived in relation to health, and more specifically in accessing gender sensitive healthcare. 14 , 17 , 18 The Kyiv (Kiev) Declaration on Women’s Health in Prison specifically recognises that women in prison may need support and assistance as they go through the menopause, and this recognition is reflected in some prison policy. 19 For example, in the United Kingdom, Standard 7.14 of the Gender Specific Standards for Women in Prison to Improve Health and Well-being notes that ‘women in prison should have access to support for the menopause’, ‘including access to hormone therapy treatment’ and other forms of support including ‘the ability to change their sheets frequently because of night sweats and information regarding lifestyle changes to improve symptoms’. 20 However, research suggests that women in prison often do not have sufficient access to medical interventions or lifestyle changes to relieve menopausal symptoms. 2 , 17 , 21 For example, research from Bosnia and Herzegovina 22 notes a perceived lack of support for women in prison in relation to the menopause. Similarly, in America, although some policies discuss menopause, they do not inform women about potential menopause treatments. 18 , 23 These inconsistencies sharply draw into focus the chasm between policy and practice, that can compound the suffering of women in prison in relation to menopause. In part, this lack of focus on the gender-specific health needs of (older) women in prison may be owing to the fact that penal policy and resources are often focused on (younger) imprisoned men as the majority of the prison population globally; however, women are disproportionately at greater risk for a larger range of physical and mental health conditions and more frequently access healthcare services than male prisoners. 5 , 14 , 24 – 30 More specifically, research from the United States, 30 , 31 Australia 32 and Portugal 25 highlights significantly worse health for older women in prison than younger female prisoners, male prisoners or their nonincarcerated counterparts. With the growing sub-population of women in prison transitioning to menopause, improved understanding of their unique experiences and support needs is imperative to inform and improve relevant policy, programming and practice. A previous scoping review has been undertaken exploring menopause and imprisonment 16 ; however, whilst an informative and thorough review, this study adopted a human rights perspective to explore menopausal women’s access to age- and gender-sensitive healthcare in prison. Synthesising findings from both qualitative and quantitative research, this review adopts a feminist criminological perspective to explore the broader experiences and support needs of women transitioning to the menopause in prison. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 33 guidelines have been adopted to examine reporting and other biases in a systematic way.

A systematic review was conducted. The two-stage search consisted of a database search and citation search. A population, concept and context framework was used (see Table 1 ) to guide the selection of terms used in the search strategy and to formulate the following research question: What are the experiences and support needs of women in prison in relation to the menopause? PCC framework. PCC: population, concept and context. A total of five bibliographic databases were searched to identify studies which empirically investigated the experience and/or support needs of those who are or have experienced the menopause during imprisonment. Specifically, Web of Science, ProQuest, JSTR, Ovid Medline and Google Scholar were searched. The search protocol was designed by the reviewers who have expertise in prison research (KL and TW) and review methods (KL), in consultation with an academic librarian. The database searches were first conducted in June 2023 and then revisited in November 2024 to check for new publications. Adopting an inclusive approach, the search was not restricted by publication date, geographical origin or methodology and applied an extensive range of search terms to full text. Keywords and terms to facilitate the search were derived from a pilot search and researcher expertise in the subject fields. Searches were expanded or restricted using Boolean operators (e.g. OR, AND) and truncations (e.g. Including *; see Table 1 ). In total, the initial search returned 33,038 articles. Article titles were then screened by KL for relevance using the criteria shown in Table 2 , and duplications were removed. Abstracts of the 313 remaining articles were then screened with exclusion made based on the criteria (where the methodology of the article was unclear within the abstract, the methodology section of the article was examined). As an inter-reliability check, a sample of the excluded articles was reviewed by the second reviewer (TW; 10%) using Table 2 criteria; there was complete agreement between the reviewers. The process of eliminating non-relevant articles can be seen in the flowchart (following PRISMA guidelines; see Figure 1 ). 33 Inclusion and exclusion criteria. Prisma Flow Diagram. Full-text screening was then conducted by KL on the remaining 35 articles; articles were excluded at this point in agreement with both reviewers if not sufficiently related to the subject area. Thirteen articles remained for retrieval, two of which were separate chapters from the same book, by the same author, based on the same research and have therefore been considered as one publication ( n  = 12). The updated search (November 2024) found an additional 12 articles; 11 articles were excluded (9 articles did not sufficiently address the subject area, and 2 articles were theses), with 1 article remaining for retrieval. The second element of the search strategy was a forward citation tracking of retrieved articles and systematic reviews identified in the database and internet searches detailed above. Forward citation tracking of retrieved articles was conducted by hand searching reference lists of returned articles to maximise the yield of relevant articles. This led to the identification of a further six articles for retrieval. Full-text copies of remaining articles were independently screened by KL against eligibility criteria (see Table 2 ). The second reviewer (TW) then checked a sample of reports (20%). The process was to resolve any conflict regarding the eligibility of individual reports via discussion; no disagreements emerged. However, one article was reviewed by both reviewers owing to uncertainty from the first reviewer; through discussion, and to reduce bias, it was agreed that this article would be excluded, owing to limited relevance to the overall review. This method is more effective than single screening alone. 34 To assess for bias and quality appraisal, the Critical Appraisal Skills Programme (CASP) checklist 35 was utilised by KL to critically appraise selected studies. Following the approach of McDonnell et al., 36 eight items on the checklist were utilised to score using a 3-point scoring system (1 = weak, 2 = moderate, 3 = strong) with a total score (out of a maximum of 24) calculated for each publication. About 50% of the sample were then independently reviewed by TW, with agreement between the reviewers. On completion of the appraisal 6 articles were identified as ‘high’ quality, 11 as ‘moderate’ and 2 as ‘low’. Consistent with previous reviews, to ensure a more comprehensive review, low scoring studies were included in the review; however, the scores were considered when presenting the findings of the review. 35 Data extraction was then facilitated by KL with support from TW; all text from articles presented as ‘Findings’ or ‘Results’ that specifically related to menopause and imprisonment was extracted and placed on a Word data extraction form. The form was uploaded onto a secure university site, enabling reviewers to collaborate on the document online simultaneously, whilst facilitating an iterative process of checking for accuracy and ensuring that no useful information was missed. 17 , 37 Data were then reviewed and agreed upon by both researchers, with any discrepancies resolved through discussion. Data were subsequently analysed and inductively coded using thematic analysis, 38 keeping the synthesis close to the original findings of the individual articles. Thematic analysis was informed by a feminist criminological perspective aiming to illuminate and prioritise the perspectives of women in prison, highlight the structural and systemic barriers they encounter 39 in relation to the menopause and explore the diverse layers of suffering that can compound and exacerbate the experiences of both menopause and imprisonment for this group of women.

Table 3 presents a summary of the characteristics of the 19 included studies. The studies were conducted in a range of geographical locations, including the United States ( n  = 7), UK ( n  = 5), Canada ( n  = 3), Brazil ( n  = 1), Cameroon ( n  = 1), Pakistan ( n  = 1) and Ireland ( n  = 1). Seven studies reported receiving ethical approval from a University Ethics panel/board and/or prisons or health ethics board. Seven studies referred to ethical procedures being adhered to, such as informed consent and anonymity but without identifying official ethical approval being granted; and five studies made no mention of or had unclear ethics approval or procedures. Ten of the studies were qualitative in design, seven mixed methods and two quantitative. Five of the studies focused specifically on older women in prison, four on health and women in prison (some looking at specific issues, such as sleep quality and reproductive health). Two studies looked specifically at health of older women in prison. One study focused on older people in prison more generally. The focus of three studies related to other gendered elements of women’s imprisonment, such as mothering. The remaining four studies specifically focused on women in prison and menopause; two were quantitative in design and two qualitative. Sample size in many of the studies was small, and in addition, not all studies provided participant demographic information; therefore, it is difficult to ascertain if the samples were representative in all cases. Study characteristics. WIP: women in prison; DPS: Department of Public Safety; CAEFS: Canadian Association of Elizabeth Fry Societies. The review identified four main themes: (1) (un)awareness of menopausal symptoms and treatment options, (2) experiencing menopausal symptoms in the context of imprisonment, (3) barriers to managing symptoms in the prison environment and (4) positive support and responses to the menopause. The first analytical theme describes women’s limited awareness of menopausal symptoms or recognition of their own symptoms as being related to the menopause. Firdos et al. 40 identified that in a study of women aged 40–60 in prison in Pakistan, although 91.6% of women were aware of the menopause, only 8.3% were aware of the symptoms of menopause and the health effects. This was echoed across other studies. In the United Kingdom, women in Davies et al.’s 41 study described not being aware of the symptoms of the menopause or the possibility that they could be perimenopausal (the time leading up to the menopause). Similarly, in the United States, women in the study of Jaffe et al. 2 did not know their symptoms were related to menopause and instead ascribed menopausal symptoms to the flu or detoxification. Healthcare professionals and other stakeholders in the study by Davies et al. 40 were also concerned that women in prison do not tend to know the signs of menopause, with their menopause transition only being diagnosed when seeking medical assistance for other issues. In some cases, this lack of knowledge and awareness was compounded by low levels of literacy. 40 In addition to a lack of awareness of menopausal symptoms, Jaffe et al. 2 also noted a lack of awareness of women in prison in relation to treatment options which often prevented them from seeking help. Some women were concerned about potential side effects of hormone replacement therapy (HRT) and indicating a belief that medication may prolong or delay the menopause transition but not necessarily appease symptoms; with others expressing a sense that the menopause was something to be endured, but not treated. Descriptions of experiences of menopause during imprisonment emphasised both physical and psychological dimensions. Participants described hot flushes, 4 , 40 , 42 , 43 heart palpitations, 42 fatigue, 2 , 43 night sweats, 2 , 40 , 44 trouble sleeping, 4 , 40 , 45 , 46 chills, 2 migraines or headaches, 4 , 46 urinary incontinence, 4 vaginal dryness, 4 , 40 irregular bleeding, 2 , 40 breast soreness, 2 , 40 body aches, 2 , 40 , 46 and changes in hair (including hair loss), 2 , 46 nails, 46 appetite 4 and weight. 2 , 40 , 46 For some women, the physical symptoms could lead to increased feelings of shame owing to ‘odours from urinary incontinence and night sweats, blood stains on clothes and sheets’. 2 Significant impacts on psychological well-being were also described by participants across the studies. Women reporting feeling shame, and/or being sad, worrisome, stressed or irritable with minimal provocation, 3 , 4 , 40 , 46 difficulty concentrating and memory loss. 40 For some women, the psychological impacts could lead to emotional outbursts and conflicts with other women or prison staff, which could result in negative conduct records. Others described pre-existing mental ill health being exacerbated 4 , 47 including anxiety, depression, bi-polar, post-traumatic stress disorder (PTSD) 4 ; in some instances, leading to suicidal ideation. 4 Smith and Borland 48 also identified higher levels of minor psychiatric disturbance in women in prison reporting suffering from problems with menopause. The combined physical and psychological symptoms of menopause significantly interfered with the daily lives of women in prison. 46 Analysis highlighted the difficulty for women in prison in accessing supplies to manage menopause symptoms. 2 , 42 Jaffe et al. 2 described a lack of access to sanitary products, replacement underwear, clothing and clean bedding. Extreme sweating and hot flushes were worsened by limited access to ceiling fans, air conditioning, exercise and fresh air. The irregularity of periods for women experiencing the menopause transition was not considered by staff, often leading to humiliating situations for women being strip-searched. 49 Several studies described women’s desire to provide self-care, but a lack of information available to women in prison was prohibitive. 4 , 43 , 46 , 50 , 51 In addition, participants described feeling unable to make some lifestyle changes, such as removing their underwear or rolling up their sleeves, owing to fear of sanctions. 2 Despite this, studies described how women developed different strategies to cope; one participant in Ferreira et al. 46 study described singing to make herself feel better. Participants in some studies expressed a desire for alternative treatments for the menopause, including vitamins, natural supplements and holistic health approaches, 49 , 52 particularly where women were concerned about the combination of HRT with existing medications. Such provisions were sometimes available to buy from the prison but were of poor quality. Consequently, some women relied on vitamins being sent in from outside. 53 Challenges in accessing professional healthcare and pharmacological treatments were also identified. Jaffe et al. 4 noted that HRT was underused with women in prison (in comparison to women in the community) and acknowledged the range of health issues and associated medications which can constrain the use of HRT for this population. In addition, Jaffe et al. 2 highlighted how women were treated with suspicion by prison professionals when seeking medical support with menopause, with the assumption they were looking to get high and with knowledge of their own bodies often dismissed. Women’s lack of knowledge of available treatment options and their implications also prohibited them from seeking help, owing to fear of the potential side effects. Several studies identified a lack of menopause focused support and understanding within the prison. 2 , 41 , 44 , 47 , 49 – 51 , 54 A lack of understanding by staff of the experience of menopause 4 and of treatment options 47 was also identified. Jaffe et al. 2 found that menopause was treated by professionals in the prison as something that should be ‘endured’, with women feeling dismissed or distrusted when seeking support. Similarly, Paynter 44 found that women were often treated for individual symptoms, such as insomnia, rather than taking a holistic approach to menopause. In addition, Baldwin and Epstein 47 and Wahidin 49 noted the implications and side effects of a lack of continuity of HRT when women were received into custody. Financial implications were also cited as a further barrier to accessing medical care in the United States; Jaffe et al. 2 noted women in prison would have their wages reduced (for their prison jobs) when attending medical appointments and were therefore reluctant to seek help. The lack of services and information exacerbated the stress and anxiety felt when experiencing menopause in prison. 51 A further and smaller theme identified within the review was women’s positive responses to the menopause, and of positive sources of support provided within the prison. Some women (85.4%) in the study by Firdos et al. 40 in Pakistan were happy with their transition to menopause and were glad to not be experiencing their menstrual cycle; in this study, women were more likely to manage their symptoms without medication. Further rehabilitative opportunities were presented for post-menopausal women in Cameroon; once considered to be past childbearing age (with institutional fears for women becoming pregnant receded), some women were then permitted to work outside of the prison. 55 Despite limited advice and support identified across the studies, where this was provided, it was received positively 2 and women were able to implement this support/information into self-care. Peers transitioning to menopause were also identified as important sources of psychosocial support, which were often underutilised. 2 , 50 Such support enabled women to voice concerns they may not feel comfortable doing with a prison practitioner and served to make them feel less isolated.

This review aimed to investigate the experiences and support needs of women in prison transitioning to menopause. The findings of this review illustrate the lack of available research in this area. Only four studies specifically focused on women in prison and the menopause: with only two collating in depth accounts from women prisoners, both with small samples. Although the 19 included studies mostly did not elicit in-depth narratives from women about their experiences of and support needs during the menopause, the findings do provide some important insights: highlighting the ongoing challenges women in prison experience with menopause, including limited awareness of symptoms and treatment options, and the barriers to managing menopausal symptoms within the prison environment. The menopause is poorly understood and treated in the general population 41 , 56 , 57 ; however, the impact of this is magnified in the prison setting where women have much less autonomy over their bodies and are less able to access information. 41 For women in the community, the primary sources of information to learn about the menopause and available treatments are online resources, such as websites and social media, medical professionals and family, friends and co-workers. 56 , 58 However, digital exclusion, 59 , 60 fractured familial relationships and support networks 61 – 64 and limited access to healthcare 65 , 66 prior to and during imprisonment, can impede accessing information from these sources. In addition, there are significant cultural variations in attitudes and perceptions in relation to the menopause, which may impede some women from talking about or accessing support and information. 67 , 68 The lack of information means that women in prison often attribute their menopausal symptoms to other health conditions, medications and/or the challenge of adjusting to imprisonment. 2 This was reiterated in the study by Davies et al., 41 who found that diagnosis of menopause was often only flagged when women accessed healthcare for other medical issues. Gaining recognition of menopause for women in prison is often complicated owing to the myriad of other health issues that women in prison often face 2 , 4 and a lack of understanding of menopause and the intersection of menopause and the complex histories of women in prison, from prison staff. This lack of access to information and awareness serves to disempower women in prison from managing their menopause, impeding their ability to manage other aspects of their prison and resettlement experience, which inevitability compounds their suffering and negatively impacting their rehabilitative opportunities. In line with existing research in relation to the provision of menopausal support, 69 where information and advice is provided for women experiencing the menopause in the prison environment, the review highlights those women felt empowered, and able to maintain a sense of agency and contribute to their own well-being. This is not to advocate for a neo-liberal approach to women’s healthcare (that has been well critiqued by feminist scholars 70 ), but a partnership approach in which prison services recognise and respond to the gender-specific needs of women in prison, enabling self-care. The menopausal symptoms of women in prison highlighted within this review are consistent with those of women in the wider population. 56 , 71 However, this review highlights the unique implications of and challenges to managing these symptoms within the context of imprisonment. More specifically, the prison environment (and associated policies and practices) impedes women’s opportunities to make lifestyle changes to manage their symptoms, such as more frequent showering and changing clothes and bed sheets, leaving them living with ongoing discomfort and embarrassment. 4 In addition, women were often met with suspicion when asking for help in making such changes, leaving them less likely to seek support. 4 Such poor practices from prison staff can reinforce women’s feelings of powerlessness over their bodies and reproduce many of the dynamics of abuse they may have previously experienced, 72 and can therefore be inadvertently retraumatising. 73 The lack of facilities and inadequate care, coupled with the inaction and apathy of those in positions of power compound the suffering of women in prison in relation to the menopause. The review also highlights the challenges of the psychological symptoms of menopause in the context of imprisonment; in particular, increased anger and frustration can leave women living in a state of fear owing to the potential repercussions of altercations with other women or prison staff. Consequently, women in prison can become increasingly isolated during the menopause transition, having significant implications for their well-being, and their progression through the prison system, resettlement and prison experience. Consistent with other research, the review has highlighted that adverse life experiences, such as trauma, stress and ill mental health can exacerbate menopause symptoms. 56 , 74 As the female prison population has disproportionately high rates of mental ill health and trauma than the general female population, 28 , 50 , 75 , 76 and rates of PTSD than male prisoners, 77 women in prison are likely to endure more extreme menopausal symptoms than the general female population. Indeed, Jaffe et al. 2 identified the impact of menopausal symptoms leading to suicidal ideation in some instances of women in prison. Feminist criminologists have long condemned the disproportionate use of imprisonment as a response to the offending behaviour of ‘vulnerable’ women; and whilst the need for alternative approaches have been acknowledged in recent policy (in the United Kingdom 78 ), the chasm between policy and practice serves to sustain the suffering and inevitable retraumatisation of women in prison. Trauma Informed Practice has become a common and welcome criminal justice policy agenda, 73 , 79 , 80 particularly in the United Kingdom and the United States. Evaluations of the approach are limited and highlight challenges in operationalisation 73 , 81 ; however, where effective, women indicate feeling safer, more visible and more understood, with increased trust between themselves and prison staff. 81 Therefore, a trauma-informed approach to menopause for supporting women in prison would be beneficial in encouraging and supporting women to seek and access support. There are different cultural responses to ageing and the menopause. 3 , 40 , 82 For example, cultures that attribute women’s worth to fertility, and/or place a high value on youthfulness, particularly in relation to women’s sexual attractiveness, can lead to more negative attitudes towards and experiences of menopause. 83 However, in Eastern cultures where menopause is viewed as a natural process and is constructed as a more positive event, the prevalence and severity of symptoms are less common. 84 Similarly, this review identified different responses to the menopause in prison, from shame in the United Kingdom, 3 to the transition being welcomed for women in Pakistan. 37 However, shame in the context of menopause and imprisonment is a complex and multi-faceted issue. Feminist research has long highlighted issues of shame in relation to older women in society (particularly in Western societies) owing to the cultural value of youth, leading to older women often feeling degraded, discounted, and marginalised 3 , 85 , 86 and particular shame expressed in relation to the menopause. 56 , 86 In addition, feminist research has consistently highlighted the shame expressed by women in prison, 72 , 87 – 89 with distinct shame experienced by older women in prison. 50 Shame operates as a further penal power that sustains the suffering of women in prison through silence and isolation, preventing them from seeking support. 67 , 68 However, where women can share their stories with others with similar experiences, this shame can be impeded. 56 , 86 Indeed, this review identified the value of peer support for women in prison transitioning to the menopause. 2 , 50 This finding is consistent with Lockwood 56 who identified that ‘collective wisdom’ and ‘feeling of community’ were key benefits identified by women who were part of a community menopause project. Similarly, the value of peer support for women in prison has been acknowledged in previous research, which highlights that women value the reassurance, information and social networks of peer support provision. 90 , 91 However, the review highlighted limited evidence of peer support in relation to the menopause and where noted, this was considered underutilised. 2 , 50 Although the overall quality of the included articles was satisfactory, there were some limitations in the methodology used in the reviewed studies. There was insufficient information on ethical issues and unclear descriptions of the design, participant selection and analysis process in some studies. The limited information in relation to participant demographics is significant and may have potentially introduced a bias, particularly as the population of women in prison (especially in the United Kingdom, Australia, and the United States) are disproportionately from ethnically minoritised backgrounds. 14 , 28 , 92 In addition, the review demonstrates a lack of available internationally published material that exhaustively captures the narratives of women in prison experiencing the menopause. The studies available are predominantly from high-income countries in the Global North, meaning diverse perspectives are limited. The restriction on the search strategy to include articles only published in English may have contributed to this limitation and potentially introduced a further bias. There are differences in biological and hormonal changes in women of different races and ethnicities, 68 , 77 , 82 and significant differences among women’s perceptions, attitudes and expectations surrounding the menopause. 68 , 82 There is therefore a need for more research to understand the impact of race, ethnicity and culture on women’s menopause transition in prison.

The population of women experiencing the menopause in prison is increasing globally. The systematic review has highlighted that the menopause in the context of imprisonment remains poorly understood, and there is a significant need for advances in research, policy and practice. The findings have significant implications for international policy and practice. The lack of awareness of the menopause, symptoms and treatment options for women in prison, accompanied with a lack of perceived understanding from professionals, highlights the distinct and urgent need for education and knowledge exchange. Imprisonment can provide a unique opportunity to educate women about the menopause, [re]connect them with healthcare, enabling them to manage their transition to the menopause both during and after prison more effectively. Access to gender-specific medical advice from expert practitioners that understand the intersection of the complexity and multiple issues faced by women in prison (physical and mental ill-health; experiences of trauma), the menopause and potential treatments, is essential to prevent further suffering and [re]traumatisation. Information should include both hormone and non-hormonal treatments and advice and attention in relation to lifestyle changes, such as exercise and diet. It is important that this information and education is sensitive and appropriate to the needs of women from different cultural backgrounds and to the level of understanding of the individual woman. The review has also highlighted the need for specialised training for prison personnel to support women in recognising their symptoms and accessing support in an empathic manner. Responses to menopausal women in prison from prison staff were highlighted in the review as often exacerbating symptoms and impeding further support seeking. The myriad of disadvantages, including complex mental and physical health challenges, and histories of abuse, experienced by women in prison 14 , 28 , 93 calls for a holistic and trauma-informed approach 79 , 80 to the menopause which would require a multidisciplinary commitment by experts and practitioners. Echoing previous research 90 , 91 with women in prison, and in relation to menopause support in the community, 56 the value of peer support has been highlighted. However, as a currently underutilised support mechanism, this is something that should be explored further in research, implemented in policy and facilitated in practice. In addition to policy and practice implications, this review has highlighted significant gaps in knowledge, indicating further research is required. An in-depth qualitative exploration, informed by a feminist approach that centres the perspectives of women in prison transitioning to and post menopause is urgently required. It is imperative that future research adopts an intersectional and trauma-informed approach, to fully consider the diverse responses to, experiences of, and support needs of women in prison in relation to the menopause. Ethics approval and consent to participate: Our study did not require an ethical board approval because it did not contain human or animal trials.

Supplemental material, sj-docx-1-whe-10.1177_17455057251367843 for Menopause and the prison: A Systematic review exploring the experiences and support needs of women in prison in relation to the menopause by Kelly Lockwood and Toni Wood in Women's Health Supplemental material, sj-docx-2-whe-10.1177_17455057251367843 for Menopause and the prison: A Systematic review exploring the experiences and support needs of women in prison in relation to the menopause by Kelly Lockwood and Toni Wood in Women's Health Supplemental material, sj-docx-3-whe-10.1177_17455057251367843 for Menopause and the prison: A Systematic review exploring the experiences and support needs of women in prison in relation to the menopause by Kelly Lockwood and Toni Wood in Women's Health