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Background: Sexual assault and/or sexual harassment during military service (military sexual trauma (MST)) can have medical and mental health consequences. Most MST research has focused on reproductive-aged women, and little is known about the long-term impact of MST on menopause and aging-related health. Objective: Examine associations of MST with menopause and mental health outcomes in midlife women Veterans. Design: Cross-sectional. Participants: Women Veterans aged 45–64 enrolled in Department of Veterans Affairs (VA) healthcare in Northern California between March 2019 and May 2020. Main Measures: Standardized VA screening questions assessed MST exposure. Structured-item questionnaires assessed vasomotor symptoms (VMS), vaginal symptoms, sleep difficulty, depressive symptoms, anxiety symptoms, and posttraumatic stress disorder (PTSD) symptoms. Multivariable logistic regression analyses examined associations between MST and outcomes based on clinically relevant menopause and mental health symptom thresholds. Key Results: Of 232 participants (age = 55.95 ± 5.13), 73% reported MST, 66% reported VMS, 75% reported vaginal symptoms, 36% met criteria for moderate-to-severe insomnia, and almost half had clinically significant mental health symptoms (33% depressive symptoms, 49% anxiety, 27% probable PTSD). In multivariable analyses adjusted for age, race, ethnicity, education, body mass index, and menopause status, MST was associated with the presence of VMS (OR 2.44, 95% CI 1.26–4.72), vaginal symptoms (OR 2.23, 95% CI 1.08–4.62), clinically significant depressive symptoms (OR 3.21, 95% CI 1.45–7.10), anxiety (OR 4.78, 95% CI 2.25–10.17), and probable PTSD (OR 6.74, 95% CI 2.27–19.99). Results did not differ when military sexual assault and harassment were disaggregated, except that military sexual assault was additionally associated with moderate-to-severe insomnia (OR 3.18, 95% CI 1.72–5.88). Conclusions: Exposure to MST is common among midlife women Veterans and shows strong and independent associations with clinically significant menopause and mental health symptoms. Findings highlight the importance of trauma-informed approaches to care that acknowledge the role of MST on Veteran women's health across the lifespan. [ABSTRACT FROM AUTHOR]