“Menopause” refers to the cessation of menses. The term “perimenopause” is the stage of life leading up to the last menstrual period and including the following 12 months after the last period. When there have been no periods for 12 consecutive months, a woman is considered “post-menopausal.” Menopausal symptoms, associated with a decrease in the hormone estrogen, can be associated with all menopausal phases: pre-, peri-, and post-menopause. Symptoms include menstrual cycle changes during perimenopause, hot flushes, night sweats, insomnia (including nocturnal awakenings), fatigue, muscle or joint pain, vaginal dryness and discomfort during sex, urinary symptoms, and mood changes including anxiety. Symptoms associated with menopause can have a substantial effect on quality of life with a significant proportion reporting that menopausal symptoms interfere with work performance. Treatment includes hormone replacement therapy (HRT) and other pharmaceuticals, all of which can have serious side effects. Other therapeutic options are needed. The endocannabinoid system (ECS) provides the physiological basis for why MC and key components might be useful in alleviating symptoms associated with menopause. The ECS is involved in homeostasis of our bodily systems relevant to symptoms associated with menopause, regulating sleep, emotions, memory, appetite, energy metabolism, pain and analgesia, bone metabolism, and more and there is a complex interplay between the ECS and estrogen. Components of cannabis interact (directly and indirectly) with the ECS. A small number of preclinical studies using ovariectomized animal models of menopause provide some evidence that major phytocannabinoids found in cannabis, cannabidiol (CBD), and tetrahydrocannabinol (THC) may reduce changes associated with reduction of estrogen, in particular in bone that are relevant to osteoporosis. Surveys indicate that menopausal women are using medicinal cannabis (MC) to treat symptoms associated with menopause including sleep problems, anxiety/mood and muscle/joint achiness. However, to date there have been no published clinical studies assessing efficacy of MC in the treatment of menopausal symptoms, though an observational study is underway now (2025) in Australia. Thus, at this point, we need to rely on studies in non-menopausal populations. Research into MC for treatment of menopausal symptoms is clearly needed.