Objectives: This cross-sectional observational study aimed to evaluate mucoscopic mucosal changes in the oral cavity across different menopausal stages and to assess the independent effects of menopause and aging on these features. Materials and Methods: A total of 150 female participants aged 30–70 years were classified into three menopausal status groups (n = 50 each). Mucoscopic examination was performed to assess 11 vascular and mucosal features, including capillary regularity, megacapillaries, white dots, hyperkeratosis, targetoid brown round areas, and yellowish-white streaks. Statistical analyses were conducted to compare the distribution of features between groups and to investigate correlations with menopausal status and age. Results: Significant differences were identified in six mucoscopic features across menopausal stages. Specifically, menopausal women exhibited decreased capillary regularity and increased presence of megacapillaries, white dots, hyperkeratosis, targetoid brown round areas, and yellowish-white streaks (p < 0.05). While aging was associated with certain microvascular changes, menopause itself independently contributed to alterations in capillary architecture and mucosal integrity. No significant differences were observed in the prevalence of dot vessels, microhemorrhages, tortuous vessels, purple areas, or microaneurysms across menopausal or age groups. Conclusions: Mucoscopy is a valuable non-invasive method for detecting oral microvascular and mucosal alterations associated with the menopausal transition.