OBJECTIVE: Occupational noise exposure and psychological distress are significant occupational health risks faced by working women, both of which may affect reproductive health. This study aimed to investigate the correlational pathways and interaction patterns linking occupational noise exposure levels, psychological distress, and reproductive aging among perimenopausal female workers. METHODS: Of the 5463 female workers screened, 1030 eligible workers (age: ≥40 years; 737 noise-exposed and 293 controls) were analyzed. Individual noise exposure, such as 8-h equivalent sound level (LA eq,8h), was first measured, followed by the assessment of psychological distress using the Depression, Anxiety, and Stress Scale. Three reproductive aging outcomes-perimenopausal syndrome (measured by the Kupperman Index), early menopause, and self-reported premature ovarian insufficiency (POI)-were recorded using a structured questionnaire. Finally, Bayesian network models explored the correlational pathways, with a generalized additive model (GAM) used to model multiplicative interaction associations. RESULTS: The prevalence rates of perimenopausal syndrome, early menopause, and self-reported POI were 37.77%, 21.26%, and 4.95%, respectively. Bayesian network analysis identified statistical direct correlations between the noise exposure levels and perimenopausal syndrome, as well as statistical indirect correlations between noise exposure levels and perimenopausal syndrome and self-reported POI via psychological distress. Furthermore, additive synergistic associations were detected between the noise exposure levels and psychological distress for perimenopausal syndrome (synergy index [SI] = 2.53, 95% confidence interval [CI]: 1.30-12.53) and early menopause (SI = 2.48, 95% CI: 1.28-12.18). The GAM confirmed a significant interaction only for perimenopausal syndrome, with a relative excess risk due to interaction of 1.10 (95% CI: 0.36-1.84) and an excess risk of 21.63% (95% CI: 2.02-45.01). Conclusion Perimenopausal female workers exposed to noise displayed high prevalence rates of psychological distress and perimenopausal syndrome. Noise exposure levels and psychological distress exhibited combined correlations with reproductive aging outcomes, particularly perimenopausal syndrome. Thus, integrated management of noise and psychological distress warrants attention to potentially improve female workers' reproductive aging outcomes.