Objective To explore the pathways and effects of factors associated with fatigue among perimenopausal women through constructing structural equation model, so as to provide theoretical evidence for improving their situation.

Methods Stratified cluster sampling was used to recruit 580 perimenopausal women at Liangjiatun community, Zhuzhuangzi village and Jianggezhuang village in Tangshan, Hebei. Questionnaire survey was used to collect data including general information, the Chinese version of multidimensional fatigue symptoms scale(short), the improvement of symptoms of the menopausal transition scale, social support rating scale, family care index scale, Pittsburgh sleep quality index scale, and flow adjustable center depression self rating scale. AMOS 22.0 was used to construct structural equation model to analyze the factors and the action path associated with fatigue.

Results The score of fatigue among perimenopausal women was (15.41 ± 13.01). The structural equation model fitted well (AGFI = 0.975, CFI = 0.999, RMSEA = 0.044). The effects of each factor on fatigue from high to low were perimenopausal symptoms, depression, family care, sleep quality and social support, respectively of whih sleep quality had the strongest direct positive effect on fatigue. Perimenopausal symptoms had indirect effects through family care, social support, depression and sleep quality. Depression had indirect effects through social support and sleep quality. Family care had indirect effects through social support, depression and sleep quality.

Conclusion Perimenopausal women‍'‍s fatigue is affected by physiological, psychological and environmental factors. Alleviating perimenopausal symptoms, improving sleep quality, regulating negative emotions, promoting family harmony and encouraging active participation in social activities are effective ways to relieve fatigue.