Background: Menopausal symptoms can affect the quality of life (QoL) of women. Objectives: To determine menopause-related symptoms and QoL in peri- and postmenopausal women in Thailand undergoing various treatment. Methods: A prospective cohort study was conducted at 9 menopause clinics in 4 regions of Thailand. Peri- and postmenopausal women newly registered at the clinics were recruited and followed up for 12 months. A standardized medical record form was used to collect data regarding demographic characteristics, menopause-related symptoms, and treatment. QoL was evaluated using a specific questionnaire. Results: We included 870 women who were 51.8 ± 5.6 years old. We compared demographic characteristics and baseline health profiles of women with normal QoL and impaired QoL. Women with impaired QoL were significantly younger (51.2 ± 4.4 vs. 52.0 ± 6.0 y, P = 0.035) and included more from northeast Thailand (11.4% vs. 6.6%, P = 0.022). The 3 most common menopause-related symptoms were psychoemotional distress, musculoskeletal pain, and hot flushes. All QoL scores improved with time in both users and nonusers of postmenopausal hormone therapy (pHT), and the scores of both groups converged during months 3 to 12 of the follow-up period. Conclusions: The most common menopause-related symptom in peri- and postmenopausal women in Thailand is psychoemotional distress. QoL scores of women with moderate-to-severe menopause-related symptoms at baseline improve over time, whether or not they use of pHT. The pHT users had poorer QoL at baseline than nonusers, but their QoL improves and matches that of their peers after 3 months.