Studying the emotional disorders of perimenopausal women and their influencing factors from a psychological perspective is essential for developing targeted psychological interventions and support strategies. Such efforts can help middle-aged and elderly women better cope with the challenges of perimenopause and improve their overall quality of life. This study aimed to explore the chain mediating effect of self-esteem and psychological resilience on the relationship between illness perception and emotional disorders in perimenopausal women in Macau. A total of 617 postmenopausal women completed the Brief Illness Perception Questionnaire, Psychological Resilience Scale, Self-Esteem Scale, and Hospital Anxiety and Depression Scale. Results revealed a significant positive correlation between illness perception and emotional disorders. Illness perception was found to have a significant direct effect on emotional disorders and an indirect effect through the mediating roles of self-esteem and psychological resilience, both independently and sequentially. These findings indicate that illness perception directly influences emotional disorders in postmenopausal women in Macau and indirectly impacts them through self-esteem and psychological resilience, offering valuable insights for psychological intervention strategies.