A Prison Policy Initiative review published September 1 found menopause mentioned in only 10 states' public prison documents, and classified Rhode Island as having no menopause-specific policy language. RIDOC's public gynecological care policy, effective in 2020, screens for menstrual history but does not expressly address menopause.
Uprise RI · Rocco Caravaggio · September 2, 2026
A Prison Policy Initiative review published September 1 found menopause mentioned in only 10 states' public prison documents, and classified Rhode Island as having no menopause-specific policy language. RIDOC's public gynecological care policy, effective in 2020, screens for menstrual history but does not expressly address menopause.
Rhode Island's integrated prison-jail system holds an aging population, and the state's publicly posted gynecological policy contains no express guidance on menopause symptoms, hormone therapy or education — leaving what care exists undocumented for the public.
A nationwide review published this morning by the Prison Policy Initiative — a Massachusetts-based research and advocacy organization that studies mass incarceration — found that menopause, a physiological transition every woman who lives long enough goes through, is almost entirely absent from the correctional policies that states, the District of Columbia and the Federal Bureau of Prisons make public. Of the 52 systems examined, documents from only 10 states mentioned menopause at all. Rhode Island is on that list, but not in the way state officials might want.
The analysis, written by PPI senior research analyst Emily Widra, sorted those 10 into two groups: five states — Alabama, Alaska, Mississippi, Oklahoma and Oregon — whose documents actually addressed menopause, and five others, Rhode Island among them, where the word surfaced only in passing, attached to some other subject. Even in the first group, PPI concluded, not one document described a comprehensive package of medical care, symptom management or education. The full review is posted on PPI's site .
Here is the qualifier that matters, and PPI puts it in the report itself rather than making a reporter dig for it: this is a review of public documents, not an audit of exam rooms. The absence of the word "menopause" from a published policy does not establish that a facility provides no menopause-related care, since clinical protocols are frequently unpublished; and the presence of the word in a policy manual does not establish that anyone follows it. What the review measures is written policy and transparency. That is a narrower claim than the headline instinct wants, and it is also the claim the evidence supports.
Rhode Island's contribution to the ledger is Policy 18.53-3, "Gynecological Care, Pregnancy Counseling and Perinatal Care for Women Inmates," effective September 21, 2020, and still listed as the department's gynecological care policy on the Rhode Island Department of Corrections' public policy index. Its stated purpose is access to gynecological and reproductive health care consistent with community standards. It requires an intake assessment tailored to women's health, with screening questions about the menstrual cycle, the date of the last menstrual period, unusual bleeding, contraception and pregnancy. It covers pelvic exams, Pap smears, annual breast examinations, mammography according to national standards, pregnancy counseling and perinatal care. What it does not do — and this is the whole of PPI's Rhode Island finding — is expressly address menopause, hormone therapy, hot flashes, cooling accommodations, or education about the transition itself.
The symptoms PPI catalogs are not exotic: hot flashes, night sweats, disrupted sleep, mood changes, brain fog, urinary symptoms, irregular bleeding, joint and muscle pain, headaches. Outside a locked facility, most people manage those with some combination of a thermostat, a cold shower, an ice pack, a fan, drugstore ibuprofen and, when that fails, a doctor. Inside, PPI argues, nearly every item on that list runs through a request slip and a staff decision — a person can't crack a window, buy an ice pack or turn down the heat in a housing unit that holds August like a stockpot working its way toward a rolling boil for a pound of ziti.
The peer-reviewed evidence on what that feels like is real but thin, and it deserves to be described honestly. In September and October of 2020, researchers Elana F. Jaffe, Aunchalee E.L. Palmquist and Andrea K. Knittel of the University of North Carolina interviewed four people in the community who had gone through menopause symptoms while held in a state prison or a county jail; their pilot study, published March 11, 2021, in the journal Menopause , reported hot flashes, fatigue, night sweats, insomnia, chills, migraines, urinary incontinence, vaginal dryness, irregular bleeding and body aches, along with inaccessible lifestyle and medical interventions and the sense that medical staff waved their concerns away. Four people is four people. The authors said so themselves. A larger qualitative study from the same research circle, published in 2025, drew on people with criminal-legal-system involvement more broadly and identified three recurring themes — shame and stigma, loss of control, and criminalization or collateral consequences.
The professional standard-setters, for their part, are not silent. The National Commission on Correctional Health Care's 2025 position statement on obstetric and gynecologic health care recommends that correctional institutions address older women's health needs, including treatment and symptom management for hot flashes and other menopausal symptoms, and provide education about the menopause transition. That is guidance from a professional body, not statute, and no facility goes to court for ignoring it.
The law sets a higher bar still. Under Estelle v. Gamble , the 1976 Supreme Court decision holding that deliberate indifference to a prisoner's serious medical needs can constitute cruel and unusual punishment, negligence and malpractice alone do not amount to a constitutional violation — and a missing paragraph in a policy manual, standing by itself, establishes nothing at all. Anyone who tells you otherwise is selling something.
What gives the policy gap weight is arithmetic. The Bureau of Justice Statistics reported in September 2025 that 91,100 women were held in state or federal prisons at the end of 2023, up nearly 4% from the year before, and that 16% of sentenced state and federal prisoners were 55 or older. PPI puts the number of incarcerated women at least 50 years old at more than 15,000. Rhode Island complicates the comparison, because BJS counts it — along with Alaska, Connecticut, Delaware, Hawaii and Vermont — as an integrated system in which prisons and jails are tallied together, so people who would be jail detainees in Massachusetts are Rhode Island prisoners on the federal books.
What the public record here cannot tell you is how many women in RIDOC custody are 45, 50 or 55 and older, how many have asked for symptom relief, or what they got. The state's policy index still shows 18.53-3, effective almost six years ago to the day. Menopause keeps its own schedule, with or without a policy number.
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Shepard said that when he asked the the Warden about the letter of grievances, the Warden repilied, "that I wouldn’t be getting a response then he smiled and continued to walk off when I further asked him about the progress of the investigation.“ This has led Shepard to view his being placed in solitary as retaliatory in nature “because I continue, in a positive way, to directly address the harsh confinement of prison conditions not only on behalf of myself, but on behalf of the prison population.”