Public Discourse on Menopausal Skin Management: A <scp>YouTube</scp> Infodemiology Study of Treatment Perceptions, Sentiment, and Unmet Needs Across 43 954 Viewer Comments

ABSTRACT Background Menopausal skin changes carry significant psychosocial burden yet remain clinically under‐addressed. As women increasingly turn to digital platforms for information and peer experience, YouTube viewer comments represent an underexplored source of real‐world treatment perceptions at scale. Methods Cross‐sectional infodemiology study using the YouTube Data API v3 (14 March 2026). 342 videos yielded 43 954 analyzable comments after automated cleaning (350‐comment/video cap). Videos were classified into four content‐type categories (Cohen's κ = 0.934). A 13‐category management subcorpus ( n = 10 861; 24.7% of full corpus) was constructed by pre‐specified keyword matching. Results The study corpus showed predominantly positive sentiment (59.6% positive, 19.1% negative; median 0.36, IQR 0.00–0.73). Hormone replacement therapy (HRT) dominated the management subcorpus (54.8%) yet generated the lowest sentiment of any category (median 0.10; 30.2% negative), differing significantly from all others ( p &lt; 0.001). Alternative approaches (median 0.72; 77.7% positive) and supplements (median 0.50; 74.6% positive) attracted the highest positivity. Personal/lifestyle content generated higher positivity (median 0.59; 70.6%) than clinician content (median 0.32; 57.7%; p &lt; 0.001). Following the FDA's November 2025 HRT boxed warning removal, a higher proportion of positive HRT comments was observed in the post‐announcement period (53.1% vs. 50.5%; p = 0.126) over the 4.5‐month available window. A negative temporal trend was observed over 116 months (Spearman ρ = −0.424, p &lt; 0.001). Conclusions HRT generates the most negative public commentary of any management category, while supplements and alternative approaches attract positivity disproportionate to their evidence base. Clinician content elicits lower viewer positivity than lifestyle creators. Dermatologists should address HRT safety misconceptions and increase online representation of evidence‐based procedural options.