Background <p>Menopausal status may influence autonomic and hemodynamic responses during surgery because of hormonal changes affecting vascular tone and thermoregulation. However, evidence comparing perioperative physiological responses and post-anesthesia care unit outcomes between non-menopausal and postmenopausal women undergoing total abdominal hysterectomy remains limited. This study compared perioperative hemodynamic changes and early postoperative recovery between these two populations.</p> Methods <p>In this prospective observational study, 48 women (25 non-menopausal and 23 postmenopausal) undergoing elective total abdominal hysterectomy under standardized general anesthesia were enrolled. Intraoperative and recovery physiologic parameters, postoperative shivering, pain, nausea and vomiting, agitation, and consciousness were assessed and compared between groups using appropriate statistical analyses.</p> Results <p>Non-menopausal women demonstrated significantly higher postoperative HR, higher incidence of postoperative shivering, and lower body temperature than postmenopausal women (both <i>P</i> &lt; 0.05). In contrast, MAP was significantly higher in postmenopausal patients throughout the perioperative period (<i>P</i> = 0.001), although no significant time-by-group interaction was observed. HR and temperature showed a significant interaction between time and menopausal status (<i>P</i> = 0.001). No significant between-group differences were found in postoperative pain, nausea and vomiting, agitation, oxygen saturation, level of consciousness, or recovery time (all <i>P</i> &gt; 0.05).</p> Conclusion <p>Menopausal status was associated with differences in postoperative heart rate and thermoregulatory responses during recovery after total abdominal hysterectomy under general anesthesia, while overall early recovery outcomes remained comparable between groups.</p>