Objective <p>This research investigated the association among perceived stress, levels of social support, and the severity of menopausal symptoms among women in western Iran.</p> Methods <p>A cross-sectional study was conducted in Hamadan, Iran, in 2023, including a sample of 200 menopausal women. Data collection was conducted through face-to-face interviews conducted by the researcher, utilizing four instruments: a demographic and midwifery questionnaire, the Menopause Rating Scale (MRS), the Perceived Stress Scale (PSS), and the Multidimensional Scale of Perceived Social Support (MSPSS). All statistical analyses were executed in Stata software, version 14, with the statistical significance level a p-value of less than 0.05.</p> Results <p>Social support showed a significant negative association with menopausal symptom severity (<i>p</i> &lt; 0.001), indicating that higher social support is linked to lower symptom severity. Perceived stress had a significant positive relationship with symptom severity (<i>p</i> &lt; 0.001), suggesting that higher stress levels correspond to more severe symptoms. Women with two children experienced significantly more severe symptoms (<i>p</i> = 0.011). Women with three or more children reported the highest symptom severity (<i>p</i> = 0.005). Age at marriage had a significant negative association with menopausal symptom severity (<i>p</i> = 0.001), suggesting that marrying at an older age is linked to lower symptom severity.</p> Conclusion <p>This study showed that psychological and social factors, such as perceived stress and social support, have a significant role in the severity of menopausal symptoms. Therefore, psychosocial interventions, including stress management classes and family education, appear to be essential in primary care screening for postmenopausal women.</p>