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The aim of the study was to specify the prevalence and severity of menopausal symptoms, and to investigate associated factors in Chinese middle-aged women.A cross-sectional, community-based study was carried out involving 1,054 participants aged 40 to 60 years in Gongshu District, Hangzhou, Zhejiang, PR China. The presence and severity of symptoms were evaluated by having the participants complete a modified Kupperman Menopausal Index questionnaire. Serum levels of follicle-stimulating hormone and estradiol were measured. Physical and sociodemographic characteristics including height, weight, education, occupation, and income were collected. Statistical analysis was performed to identify factors associated with the occurrence of the menopausal syndrome according to the modified Kupperman Menopausal Index score rank.The mean (SD) age of all participants was 50.85 (5.55) years. Overall, 32.6% of the participants were premenopausal, 20.2% were perimenopausal, and 47.1% were postmenopausal. The three most prevalent symptoms suffered by all participants were muscle/joint pain (54.5%), sexual problems (48.7%), and fatigue (46.1%). The prevalence of sexual problems and muscle/joint pain increased from the premenopausal stage to the postmenopausal stage (P < 0.001 for both). Compared with premenopausal women, perimenopausal and postmenopausal women have a significantly increased risk of menopausal syndrome (P < 0.001 for both). The logistic regression model revealed that the place of residence and level of education were significantly associated with the occurrence of menopausal syndrome (P < 0.05).Perimenopausal women are prone to the highest prevalence and severity of menopausal symptoms. Sexual problems and muscle/joint pain are noticeable symptoms in postmenopausal women. Further studies are required to verify the influences of level of education, place of residence, and other factors on menopausal symptoms in Chinese women.