Objective: The purpose of this study was to examine the frequency and clustering of somatic symptoms as reported by women aged 45 to 55 years in four countries, to compare women’s responses to open-ended questions with those derived from structured checklists, and to assess the extent to which bodily symptoms grouped with emotional complaints. Methods: The Decisions at Menopause Study recruited 1,193 women from the general population in Beirut, Lebanon; Rabat, Morocco; Madrid, Spain; and central Massachusetts. Women participated in semistructured interviews on health, menopause, and bodily changes at midlife. The women’s responses to symptom checklists and their statements in response to open-ended questions were analyzed through factor and textual analyses. Results: There was considerable consistency between the frequencies of quantitative and qualitative responses, and analyses of qualitative data illustrate the extent to which women associate somatic and emotional complaints. As shown in their responses to the open-ended questions, the women in Massachusetts and Spain did not often cluster somatic with emotional symptoms. In Morocco, dizziness, fatigue, and headaches were clustered with emotional symptoms. Women in Lebanon explicitly associated shortness of breath, chest pain, palpitations, dizziness, fatigue, gastrointestinal complaints, headaches, and, to a lesser extent, joint pain and numbness with emotional symptoms. Conclusions: The number of volunteered symptom responses was small because the respondents were relatively healthy; however, the extent and pattern of association between somatic and emotional symptoms varied across sites. Certain somatic symptoms may be more likely to communicate psychosocial distress in particular cultures. These results have implications for patterns of healthcare utilization.