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Objective: This study aimed to determine the associations among menopausal status, menopausal symptoms, and depressive symptoms in midlife women in Hunan, China.Methods: A secondary analysis involving 3199 women aged 40-55 years was performed based on data from the Women Health Needs Survey 2018 in Hunan Province, central south China. The depressive symptoms were determined using the 9-item Patient Health Questionnaire. The menopausal symptoms were assessed using the Kupperman Menopausal Index. Demographic characteristics and menopausal status were measured using self-administered questionnaires.Results: The prevalence of depressive symptoms was 19.3%. The three most common menopausal symptoms were insomnia (48.0%), fatigue (42.7%), and mood swing (39.8%). The increase in depressive symptoms was significantly associated with menopausal status and menopausal symptoms. After controlling for demographic variables, multivariate logistic regression showed that menopausal transition (odds ratio [OR] = 1.14, 95% confidence interval [95% CI] = 1.12-1.86), postmenopause (OR =1.52, 95% CI = 1.09-2.11), and four menopausal symptoms including mood swing (OR = 1.32, 95% CI = 1.03-1.70), depressive mood (OR = 2.28, 95% CI = 1.79-2.91), palpitations (OR = 1.37, 95% CI = 1.06-1.77), and urinary tract infection (OR = 1.49, 95% CI = 1.16-1.92) were associated with depressive symptoms.Conclusions: Independent of demographic variables, menopausal transition, postmenopause, and four menopausal symptoms (mood swing, depressive mood, palpitations, and urinary tract infection) increase the risk of depressive symptoms. [ABSTRACT FROM AUTHOR]