A review is provided of various approaches that have been adopted recently to assess the fatigue of ships and offshore structures. The relevant fatigue loading is reviewed first, focusing on the successive loading and unloading of the cargo and the transient loadings. The factors influencing fatigue strength are discussed, including the geometrical parameters, material, residual stress, and ones related to the environment. Different approaches for fatigue analyses of seam-welded joints are covered, i.e., the structural stress or strain approach, the notch stress or strain approach, notch intensity approach, and the crack propagation approach.