Public Discourse on Menopausal Skin Management: A YouTube Infodemiology Study of Treatment Perceptions, Sentiment, and Unmet Needs

Background: Menopausal skin changes carry a 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: This cross-sectional infodemiology study used the YouTube Data API v3 on March 14, 2026. A total of 342 videos yielded 43,954 analyzable comments after automated cleaning, with a cap of 350 comments per video. Videos were classified into four content-type categories, with a Cohen’s κ of 0.934. A 13-category management subcorpus was constructed using prespecified keyword matching and included 10,861 comments, representing 24.7% of the full corpus.

Results: The study corpus showed predominantly positive sentiment, with 59.6% of comments classified as positive and 19.1% as negative. The median sentiment score was 0.36, with an interquartile range of 0.00–0.73.

Hormone replacement therapy (HRT) dominated the management subcorpus at 54.8% but generated the lowest sentiment of any category, with a median score of 0.10 and 30.2% of comments classified as negative. HRT sentiment differed significantly from all other categories (p < 0.001).

Alternative approaches attracted the highest positivity, with a median sentiment score of 0.72 and 77.7% positive comments. Supplements followed, with a median score of 0.50 and 74.6% positive comments.

Personal and lifestyle content generated higher positivity, with a median score of 0.59 and 70.6% positive comments, compared with clinician content, which had a median score of 0.32 and 57.7% positive comments (p < 0.001).

Following the FDA’s November 2025 removal of the HRT boxed warning, a higher proportion of positive HRT comments was observed during the post-announcement period compared with the pre-announcement period, at 53.1% versus 50.5% (p = 0.126), based on the available 4.5-month observation window.

A negative temporal trend was observed over 116 months, with a Spearman correlation coefficient of ρ = −0.424 (p < 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 misconceptions about HRT safety and increase online representation of evidence-based procedural options.