Middle-aged women (40-65 years old) experience several bio-psychsocial changes that may impact how they feel about themselves. The desire to achieve the perfect body image may make women go through several physical and psychological problems, such as experiencing an eating disorder, having low self-esteem, and low self-confidence. This study aims to investigate body image satisfaction as a psychological reaction to age-related developmental changes among middle-aged women in Saudi Arabia. Descriptive design was used to collect responses from Saudi Arabian women between September and February 2021 using a self-report questionnaire. It consisted of the demographics section, Stunkard Figure Rating Scale, and Perceived Stress Scale. Data collection was conducted online through social media platforms. One hundred and eighteen middleaged women completed the survey. Most participants were dissatisfied with their body image and reported moderate levels of perceived stress. The paired-sample ttest indicated that middle-aged women were more likely to have a perceived body image that was thinner than their actual body image (t = 13.581, p ≤ 0.0001). Years of education (r = −0.22, p-value = .02), having a chronic disease (r = 0.24, p-value = .01), and body image satisfaction (r = −0.26, p-value = .005) were significantly correlated with perceived stress. Age, years of education, and perceived stress were significantly impacting body image satisfaction. The increase in age (Risk = .473), educational level (Risk = .51), and perceived stress level (Risk = .59) decrease the likelihood of body image satisfaction. Developmental changes make it essential for nurses to develop comprehensive preventive programs that consider all biopsychosocial changes that middle-aged women undergo.