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Background Diet is increasingly recognised as a modifiable factor influencing the severity of menopausal symptoms. While global studies have examined this relationship, there is limited evidence on how culturally specific dietary patterns relate to menopausal health among African populations.Methods A cross-sectional study was conducted among 376 postmenopausal women. Data were collected using structured questionnaires. χ 2 tests and Cramer’s V were used to evaluate associations between dietary intake and menopausal symptom severity, with post hoc standardised residuals to identify contributing categories.Results Most participants were aged 51–55 (34.8%), with vaginal dryness reported as the most severe symptom (38.6%). Menopause severity was moderate, with most (83%) respondents experiencing mild-to-moderate menopausal symptoms. Indigenous diet was moderately consumed by 51.6%, the Western diet was highly consumed by 44.7% and processed foods were moderately consumed by 91%. There were statistically significant associations between all three dietary patterns and menopausal symptom severity. For Indigenous food, moderate consumption was marginally associated with being asymptomatic (Standard Residual (SR)=+1.9), while high consumption was marginally associated with fewer asymptomatic cases (SR=–1.9) (χ²(2)=8.31, p=0.016, φc=0.149). Western food intake showed a strong inverse association, with asymptomatic women over-represented among low consumers (SR=+5.9) and under-represented among high consumers (SR=–3.1) (χ²(4)=50.09, p<0.001, φc=0.495). Similarly, low processed food consumption was strongly associated with being asymptomatic (SR=+7.6), while moderate consumption was associated with fewer asymptomatic cases (SR=–2.5) (χ²(4)=78.21, p<0.001, φc=0.795).Conclusion The associations between dietary patterns and menopausal symptoms severity reflect potential influences of varied dietary patterns on the menopause symptom experiences. These associations suggest that culturally relevant dietary strategies may contribute to managing menopausal symptoms among Nigerian women, warranting further longitudinal investigation.