To identify the development trajectory of chronic diseases among menopausal women and its influencing factors，and to provide a reference basis for the health management of menopausal women，this study utilized five waves of data spanning 2011-2020 from the China Health and Retirement Longitudinal Study （CHARLS）. A total of 3 508 women aged 40-54 at baseline were selected as subjects. Group-based trajectory modeling （GBTM） was employed to identify their chronic disease developmental trajectories，with further subgroup analysis conducted by birth cohort. Results indicated three types of developmental trajectories of chronic diseases among menopausal women: low - level slow growth （21.3%），moderate - level steady growth （60.6%），and high-level rapid growth（18.1%）. Trajectory analysis classified by birth cohort further revealed the same three categories. Compared to the 1957-1961 birth cohort，the 1962-1971 cohort had a higher proportion in the low-level group and a lower proportion in the high-level group. Logistic regression analysis indicated that menopausal status，sleep，smoking，and employment status were the main influencing factors for trajectory classification. These findings revealed heterogeneity in the developmental trajectories of chronic diseases among menopausal women. Therefore，the study proposes implementing stratified interventions alongside strengthening health education on chronic disease prevention and control，and providing personalized health services to facilitate a smooth menopausal transition.