Menopause care in Brazil: policy recognition and the challenge of implementation.

Brazil is undergoing rapid demographic aging, with millions of women living decades beyond menopause. Despite having a universal public health system and one of the world's largest primary healthcare (PHC) networks, menopause remains inconsistently integrated into routine care delivery. Over the past four decades, Brazilian public policies have progressively expanded menopause care from a predominantly reproductive and hormone-centered model toward a broader person-centered and equity-oriented approach. The recent preliminary Brazilian Ministry of Health manual on menopausal transition and menopause reinforces the role of PHC, longitudinal care, social determinants of health and health equity in menopause management. However, substantial gaps persist between institutional recognition and implementation. Menopause care remains fragmented, unevenly prioritized and marked by regional and socioeconomic disparities in access to evidence-based therapies and trained professionals. This commentary discusses the evolution of menopause-related public policies in Brazil and argues that the main challenge is no longer recognition of menopause as a public health issue, but the operationalization of equitable and sustainable menopause care within PHC. Brazil has the potential to become a model for menopause care integration in middle-income countries if policy advances are effectively translated into routine care delivery.