Postmenopausal estrogen deficiency can lead to genitourinary syndrome of menopause (GSM), which manifests as vaginal dryness, dyspareunia, and sexual dysfunction, among other clinical symptoms. These complications often result in emotional distress and a decline in overall quality of life (7). Several studies estimate that 25–50% of postmenopausal women experience symptoms such as pain during intercourse, burning, itching, and dysuria due to vaginal atrophy and inflammation (9). Menopause is commonly diagnosed based on the absence of menstruation and hormone levels (10), but one of the simplest diagnostic methods is the evaluation of the vaginal microenvironment. There is limited data in Mongolia regarding the vaginal microenvironment of perimenopausal and postmenopausal women and the factors influencing its changes. This gap in knowledge formed the basis of our study. The aim of this research was to assess the vaginal microenvironment in menopausal women and to analyze its relationship with various influencing factors. We conducted a cross-sectional observational study using a descriptive research design. A total of 110 women aged 45–55 years, presenting with menopausal symptoms at “Santmaral” Women’s Clinic and the Women’s Outpatient Department of Songinokhairkhan Health Center, were selected for the study. Both quantitative and qualitative research methods were employed, including surveys and physical examinations. Participants completed a 10-minute questionnaire consisting of 8 open-ended and 12 closed-ended questions. The vaginal microenvironment was assessed using special pH test strips applied to vaginal secretions. Data were analyzed using Excel 21 and SPSS 23, comparing the vaginal microenvironment with various influencing factors. The results showed that the average vaginal microenvironment pH among menopausal women was 5.18 ± 0.45 (n=110). In married women, the average pH was 5.1 ± 0.45; among women with a history of pregnancy, it was 4.10 ± 1.58; and among those who had given birth, it was 2.8 ± 0.98 — indicating an abnormal vaginal microenvironment. Women who were using hormone replacement therapy had an average pH of 5.05 ± 0.45, while those using non-hormonal contraceptive methods had an average pH of 5.3 ± 0.43. These findings were statistically significant (p = 0.0001****)