Objective: The aim of the study was to examine reproductive health, use of estrogen, lifestyle, experience of menopausal symptoms and work-role related issues in a population-based sample of perimenopausal women. Methods: All women aged 48 years and residing in the catchment area of the Karolinska Hospital were recruited through the Swedish population register. They received a questionnaire covering sociodemographic background, reproductive health and gynaecological characteristics, social and work role related issues as well as a symptom rating scale. Results: Seventy percent of the women returned the questionnaire. Of these, 73% were premenopausal, 21% were postmenopausal and 6% were perimenopausal. Hormone replacement therapy was used by 7.5% of the respondents and the rate of hysterectomy was 8.6%. Regular exercise was reported by 44.4%. Factor analysis of the symptom ratings yielded four independent dimensions: Negative Moods, Vasomotor symptoms, Decreased Sexual Desire and Well-being. Multiple regression analyses showed that only vasomotor symptoms were significantly related to menopausal status. Negative Mood and Reduced Sexual Interest were better explained by the presence of vasomotor symptoms and by reproductive health and lifestyle variables such as current or previous PMS, dysmenorrhea, smoking and lack of exercise. Conclusions: Only vasomotor symptoms were significantly related to menopausal status. Psychosocial and lifestyle variables as well as past or current reproductive health are more important determinants of women's psychological well-being during transition to menopause than menopausal status.