Abstract
Women living with HIV often experience menopause earlier and with more severe symptoms, yet these are frequently misattributed to HIV, antiretroviral therapy, or aging. Drawing on lived experience, this commentary describes how lack of recognition can erode trust and compromise care. We present the four P's nursing lens (patterns, physiology, psychosocial, partnership) to complement existing guidelines. This framework emphasizes listening, thorough histories, recognition of overlapping symptoms, attention to comorbidities, addressing stigma, and partnering through shared decision making and culturally relevant resources. Centering lived experience highlights the need for compassionate, holistic care that enhances autonomy, builds trust, and makes menopause care a standard part of HIV practice across the lifespan.