Background <p>Population aging and declining fertility have transformed family life courses, yet their long-term implications for women’s health remain insufficiently understood. This study examined whether distinct marital and fertility trajectories were associated with subsequent changes in depressive symptoms and physical functional limitations among Chinese women.</p> Methods <p>We used data from the China Health and Retirement Longitudinal Study (CHARLS), including 5,871 women aged 45–65 years at baseline. Retrospective marital and fertility histories from ages 15 to 49 were reconstructed using sequence-based methods and grouped into trajectory typologies through Ward’s clustering. Depressive symptoms were assessed using the CES-D-10, and physical functional limitations were measured using the Nagi Disability Scale. Associations with longitudinal health outcomes were estimated using linear mixed-effects models. Robustness analyses additionally adjusted for childhood contexts, and sensitivity analyses restricted the sample to women with at least two valid outcome observations.</p> Results <p>Four trajectory groups were identified: Stable Marriage &amp; Two-Child (40.0%), Early Marriage &amp; High-Parity (43.3%), Stable Marriage &amp; One-Child (15.6%), and Predominantly Married &amp; Childless (1.2%). Compared with the Stable Marriage &amp; Two-Child group, the Early Marriage &amp; High-Parity group had higher baseline depressive symptoms (β = 0.858, 95% CI: 0.560 to 1.157) and higher physical functional limitations (β = 0.206, 95% CI: 0.143 to 0.269), with a faster increase in physical functional limitations over time (β = 0.025, 95% CI: 0.012 to 0.038). The Stable Marriage &amp; One-Child group had lower baseline depressive symptoms (β = -0.858, 95% CI: -1.271 to -0.445) and lower physical functional limitations (β = -0.163, 95% CI: -0.251 to -0.076), with a marginally slower increase in physical functional limitations (β = -0.018, 95% CI: -0.036 to 0.000). The Predominantly Married &amp; Childless group did not differ significantly from the reference group. These associations were broadly consistent in robustness and sensitivity analyses.</p> Conclusions <p>Women’s marital and fertility trajectories were associated with later depressive symptoms and physical functional limitations from midlife to early old age. Early marriage and high parity were linked to poorer depressive and functional outcomes, whereas the Stable Marriage &amp; One-Child trajectory was associated with relatively better depressive and functional outcomes. These findings suggest that the timing and structure of family formation may have lasting implications for women’s later-life depressive symptoms and physical functional limitations.</p>