Abstract: Objective To investigate symptom distress and barriers to seeking primary care among perimenopausal women. Methods A total of 466 perimenopausal women were recruited from communities and primary healthcare institutions in Pukou District, Nanjing from January to October 2024. Symptom distress was evaluated using the modified Kupperman Index and the Menopause Rating Scale (MRS). Barriers to seeking medical care were identified through semi-structured interviews and latent class analysis. Multinomial logistic regression was employed to analyze the associated factors. Results The prevalence of moderate to severe symptom distress was 54.94%(256/466) as measured by the Kupperman Index and 66.31%(309/466) by the MRS. Three distinct classes of barriers to seeking healthcare were identified: "hesitant and wavering" (60.09%), "system-driven" (21.89%), and "neglectful and silent" (18.03%). Multinomial logistic regression analysis revealed that rural residence (OR=5.775), lower educational attainment (OR=3.163), lower perceived symptom impact (OR=0.473), never seeking health information (OR=5.008), and non-participation in community activities (OR=5.282) were significantly associated with the "neglectful and silent" class. Rural residence (OR=3.172), moderate to severe symptom impact (OR=1.777), and primary reliance on the internet for health information (OR=2.513) were significantly associated with the "hesitant and wavering" class (all P<0.05). Conclusion A significant majority of perimenopausal women experience moderate to severe symptom distress. The predominant barrier to seeking healthcare is characterized by hesitation and indecisiveness, which is significantly influenced by factors such as residential area, educational level, and channels used to access health information.

Key words: Perimenopause, Symptom distress, Healthcare-seeking barriers, Primary care, Quality of life