Objective: To investigate and statistically analyze the prevalence of female menopausal syndrome, while assessing their understanding of hormone replacement therapy (HRT). Methods: A total of 3,200 women who visited Huangpu District Maternal and Child Health Hospital in Guangzhou from October 2021 to June 2023 were selected as the subjects of this survey. Data on their basic information, disease symptoms, and understanding of HRT were collected through questionnaires. Results: Out of the 3,200 questionnaires distributed, the top three symptoms reported were hot flashes, insomnia, and joint pain, which occurred significantly more frequently than other symptoms (P < 0.05). Regarding HRT awareness, only 11.47% of the women were relatively familiar with it, primarily sourcing their knowledge from the internet, followed by information from family, friends, and colleagues, and then from health lectures and other promotional materials. Among the menopausal symptoms, 183 women had moderate Kupperman scores, and 116 had severe scores, accounting for 5.51% and 3.49% of the total surveyed, respectively. Conclusion: The majority of women demonstrated a significant lack of understanding regarding HRT. Enhanced education and awareness campaigns, professional medical consultations, personalized treatment plans, and the correction of past misconceptions can empower more menopausal women to make informed health choices tailored to their needs, thereby improving their quality of life. Monitoring patients’ hormone levels can provide a basis for intervention and evaluating treatment effectiveness. The relatively low proportion of women with severe symptoms is a primary reason why menopausal symptoms are often overlooked by women.