Globally, persons living with HIV are aging, with women constituting over half of this group. Increasingly, women living with HIV (WLWH) are entering menopause, a crucial transition with impacts on overall health and well-being. Regrettably, there is limited research focused on how WLWH experience menopause, leading to a major gap in their quality of care. Preliminary studies suggest that WLWH may experience menopause with heightened symptoms. However, uncovering the true extent of this important relationship awaits detailed clinical analysis. Therefore, we undertake an interconnected set of aims to better understand the progression of menopausal symptoms within two Canadian cohorts of WLWH. For the first time, we evaluate how symptom severity progresses during the menopausal transition in this group. Subsequently, we assess whether hormonal imbalance underlies the increased severity of symptoms experienced in menopausal WLWH. Finally, we evaluate the clinical use of hormone therapy to treat these women which we predict is under prescribed for WLWH. By uncovering unique aspects of menopausal management in HIV, this work will enable development of tailored approaches to improve care for this vulnerable population.