Objectives <p>To investigate whether menopause is associated with adverse clinical periodontal outcomes by systematically comparing postmenopausal and premenopausal women.</p> Materials and methods <p>A systematic review of observational studies was conducted following PRISMA guidelines. Electronic databases were searched up to March 2025 March 2025 for observational studies reporting clinical periodontal parameters in postmenopausal women not undergoing hormone replacement therapy. Risks of bias and certainty of evidence were assessed using ROBINS-I and GRADE frameworks.</p> Results <p>Nine studies met inclusion criteria. Postmenopausal women showed greater clinical attachment loss, increased probing depths, and more pronounced signs of inflammation. However, the certainty of evidence was rated as moderate to low, mainly due to methodological variability.</p> Conclusions <p>While the observed trends suggest that menopause is a clinically relevant factor in periodontal health, the current evidence base is weak. High-quality prospective studies are urgently needed to confirm these findings before informing clinical practice or developing new guidelines.</p> Clinical relevance <p>Findings contribute to the current understanding of systemic influences on periodontal disease, with relevance to aging, women’s health, and menopause as a physiological stage of life.</p> Graphical abstract <p></p>