한국 여성의 월경·폐경 관리: 2022년 한국 여성의 생애주기별 성‧생식건강조사 결과

Women’s sexual and reproductive health conditions, such as menstruation, pregnancy, childbirth, menopause, and contraception, have a lifelong impact on their health, illness, and quality of life. The United Nations Sustainable Development Goals (SDGs) 2030 emphasize the importance of sexual and reproductive health to encourage healthy living and enhance universal well-being. The essential sexual and reproductive health services for women vary depending on their age and life cycle stage. Adolescence and young adulthood are crucial periods marking the beginning of menstruation and sexual behaviors, thereby necessitating education on menstruation, contraception, and human papillomavirus (HPV) vaccination. Women often experience pregnancy and childbirth during adulthood, while menopause is experienced around the age of 50 years. Thus, it is necessary to provide management for severe menopausal symptoms, prevention of osteoporosis and related conditions, and treatment for other menopause-related complications [ 1 , 2 ]. Since the discovery of toxic substances in menstrual products such as sanitary pads in 2017, there has been increased interest in the safety of such products from a women’s health perspective. However, research and discussions regarding menstruation and menopause have been very limited. Women’s menstruation begins in early adolescence and concludes with menopause in middle age. As the age of onset for menstruation is gradually decreasing, support is needed to promote healthy management of menstruation among adolescents. Considering that a significant number of women experience various menopausal symptoms and face increased health risks such as osteoporosis and cardiovascular diseases after menopause, it is important to empirically understand the current status of menstruation and menopause in women. The Korean Disease Control and Prevention Agency developed the Women’s Health Survey for Sexual and Reproductive Health, with the aim of investigating the current status of sexual and reproductive health and related health issues among Korean women in different stages of life cycle. In 2022, they conducted a survey targeting 5,567 women aged 13 years or older to investigate menstruation, menopause, contraception, and related healthcare utilization [ 3 ]. The present study aimed to ascertain the prevalence of menstrual and menopausal symptoms, management practices, and associated factors among adolescents and adults, aiming to provide fundamental data for promoting women’s health and improving their quality of life.

The 2022 Women’s Health Survey for Sexual and Reproductive Health targeted 1,019 adolescent (aged 13–18 years), 3,533 adult (aged 19–64 years), and 1,015 elderly (aged 65 years or older) women living throughout the Republic of Korea. Considering the major sexual and reproductive health issues faced by each age group, adolescents and adults were questioned about menstruation and menopause, but the elderly were not surveyed on these topics. For analysis of menstruation-related questions and responses, 3,098 women (961 adolescents and 2,137 adults) were included after excluding participants who were premenarchal (54 participants), amenorrheic (93 participants), or postmenopausal (1,101 participants). Regarding menopause-related items, we analyzed responses from 1,307 participants in the perimenopausal or postmenopausal stage. The 2022 Women’s Health Survey for Sexual and Reproductive Health was conducted online for adolescents and adults and through face-to-face interviews via home visits for the elderly. The online survey helps participants provide honest responses to potentially sensitive questions, such as those about sexual and reproductive health. However, obtaining a representative sample can be difficult when using convenience sampling. Therefore, we used a large survey panel and set quotas to ensure representativeness. Using a target sample size of 1,000 adolescents (aged 13–18 years) and 3,500 adults (19–64 years), we set quotas based on the distribution of geographical regions (17 major cities and provinces), age groups (1-year intervals for adolescents, 10-year intervals for adults), and education level (high school graduate and below, university graduate and above) in resident registration records from May 2022. For the sampling frame, we used a female survey panel of 231,246 individuals provided by a specialist survey agency. From this panel, we randomly sampled 37,896 individuals, stratified by characteristics, and conducted online surveys. A total of 4,651 participants completed the survey. After excluding data from participants who provided dishonest responses (such as repetitive identical responses or illogical responses regarding age and menstrual status), we collected data from 4,552 individuals. The online survey was conducted from July 18 to September 15, 2022. Participation in the survey was limited to individuals who were aware of the research objectives and content, and who provided informed consent for their participation and the use of the collected information. This study was approved by the Institutional Review Board of the Korea Institute for Health and Social Affairs (IRB no. 2022-052). We conducted a survey to investigate the menstrual and menopausal status of the participants using a structured questionnaire. Regarding the current menstrual status, participants were asked to choose one of the following five options: premenarche, amenorrhea, postmenarche/premenopause, perimenopause, and postmenopause. Perimenopause was defined as experiencing irregular menstrual cycles with a difference of more than 7 days from the previous regular cycles or having no menstruation for more than 6 months after the last menstruation. Menopause was defined as the absence of menstruation for more than 1 year since the last menstrual period [ 4 , 5 ]. Dysmenorrhea symptoms encompass abnormal frequency, regularity, duration, and amount of menstrual bleeding, as well as severe menstrual pain and symptoms before and after menstruation. Typically, amenorrhea is also included, but in the present study, we focused on the presence/absence and the intensity of symptoms such as menstrual pain, premenstrual syndrome, and abnormal uterine bleeding experienced in the last three years by menstruating women. Therefore, women who were currently experiencing amenorrhea were excluded from the analysis [ 1 , 3 ]. Menstrual pain (dysmenorrhea) was defined as pain related to the menstrual cycle, occurring during or before/after menstruation [ 3 , 6 ]. Premenstrual syndrome was defined as experiencing symptoms such as headache, nausea, weight gain, breast pain, bloating, fatigue, changes in appetite, anxiety, irritability, severe mood swings, depression, and edema approximately one week before menstruation [ 7 ]. Abnormal uterine bleeding was defined as bleeding occurring outside the normal range of menstrual bleeding (e.g., heavy menstrual bleeding, hypomenorrhea, irregular menstruation) or intermenstrual bleeding [ 7 ]. Participants who had experienced dysmenorrhea symptoms were asked to rate the severity of their symptoms on a visual analog scale (VAS) ranging from 1 (very mild) to 10 (very severe), and severe dysmenorrhea symptoms were defined as severity of 7 points or higher [ 8 ]. Participants who had experienced at least one dysmenorrhea symptom were asked about their coping methods and to select as many of the following choices as were applicable: visiting a hospital (e.g., gynecology or urology departments), visiting a traditional Korean medicine hospital, visiting a pharmacy (e.g., to purchase analgesics), consuming health functional foods or using folk therapy, using no specific coping method, and “others.” Participants who had dysmenorrhea symptoms but did not visit the hospital (such as gynecological or urological clinics) were asked about the main reason for not seeking medical attention. Menopausal symptoms were assessed among perimenopausal and postmenopausal women using the Korean version of the Menopause Rating Scale (MRS) [ 9 ]. The MRS consists of 11 questions on symptoms split into three categories: psychological, physical, and urogenital symptoms. Respondents rate the severity of their symptoms on a 5-point scale of “none,” “mild,” “moderate,” “severe,” and “very severe.” Severe menopausal symptoms were defined as experiencing at least one of the 11 symptoms reported as “severe” or “very severe” during the last year. Women who reported menopausal symptoms were asked about the methods they used for symptom prevention and relief, choosing all applicable options from the following: none, medical treatment (hormone therapy), treatment at a traditional Korean medicine clinic/hospital, exercise, health functional foods (e.g., pomegranate, vitamins), and “others.” This study presents the symptom management strategies utilized by participants with severe menopausal symptoms. The data were analyzed using SAS (SAS Institute).

Participants were categorized into 961 premenopausal adolescents, 2,137 premenopausal adults, and 1,307 peri- or postmenopausal women based on their age and current menstrual status. We conducted a survey to investigate the participants’ general characteristics as well as their current experiences and management of dysmenorrhea and menopausal symptoms. The survey included premenopausal adolescent women, among whom 480 were in the age group of 13–15 years (49.9%), while 481 were in the age group of 16–18 years (50.1%). There were 439 middle school students (45.7%), 477 high school students (49.6%), 23 university students (2.4%), and 22 participants were not attending school (2.3%; Table 1 ). Of the premenopausal adults, 94.2% were aged <50 years and 5.8% were aged 50 years or older. Regarding education level, 52.2% had graduated with university degree or higher, while 47.2% had graduated with high school degree. In terms of household economic status, the majority had an income of 2–3.99 million KRW (33.4%), followed by 4–5.99 million KRW (27.7%), ≥6 million KRW (26.0%), and < 2 million KRW (12.9%). Among perimenopausal or postmenopausal adults, 91.5% were aged 50 years or older, 8.0% were in their 40s, and 0.5% were in their 30s or below. The education level was highest for high school graduates at 57.2%, followed by those with a university degree or higher at 40.1%. In terms of household income, the majority had an income of 4–5.99 million KRW (33.3%), followed by 2–3.99 million KRW (30.6%), ≥6 million KRW (25.6%), and <2 million KRW (10.5%). The mean age of menarche of premenopausal adolescents and adults was 12.11 and 13.03 years, respectively. The mean age of menarche for peri- and postmenopausal women was 14.30 years, and mean age for last menstruation of postmenopausal women was 50.13 years. Among adolescents, the most commonly reported dysmenorrhea symptoms were menstrual pain (76.5%), followed by premenstrual syndrome (64.8%), and abnormal uterine bleeding (16.7%; Figure 1A ). Meanwhile, the proportion of adolescents who reported having severe symptoms (VAS score ≥7) for menstrual pain, premenstrual syndrome, and abnormal uterine bleeding was 42.6%, 29.3%, and 5.3%, respectively. This indicates that a large number of adolescents have severe dysmenorrhea symptoms. Among adults, the prevalence of premenstrual syndrome was 82.9%, menstrual pain was 77.1%, and abnormal uterine bleeding was 26.5%, indicating a higher proportion of adults experiencing premenstrual syndrome and abnormal uterine bleeding compared to adolescents ( Figure 1B ). Among adult women, the proportion experiencing severe menstrual symptoms (VAS score ≥7) was 41.6% for menstrual pain, 46.1% for premenstrual syndrome, and 8.6% for abnormal uterine bleeding. There were 503 adolescents and 1,266 adults with at least one severe dysmenorrhea symptom, and more than half of these (62.4% of adolescents and 59.2% of adults) reported visiting the pharmacy to alleviate these symptoms (e.g., by purchasing analgesics; Table 2 ). Among adolescents, the second most common response was using no specific coping method (25.5%), followed by health foods or folk therapy (11.1%). Few of the adolescents experiencing severe symptoms visited the hospital (e.g., gynecology or urology; 9.9%), and only 3.0% visited a traditional Korean medicine hospital. Following the visit to pharmacy, the next most common response among adults was visit to the hospital (28.5%), while 23.5% reported using no specific coping method, 18.2% consumed health functional foods or folk therapy, and 4.8% visited a traditional Korean medicine hospital. Thus, adults were more likely to visit the hospital for their symptoms than adolescents. We also investigated the main reasons why participants experiencing severe dysmenorrhea symptoms (VAS score ≥7) did not visit the hospital. Among adolescents, 38.9% responded that they could manage the symptoms with painkillers, 28.7% stated that the symptoms were mild, 13.3% cited lack of time, 5.7% had reservations about medical treatment itself, and 5.5% mentioned discomfort due to the judgment of others. Similarly, among adults, the majority cited the ability to manage symptoms with painkillers (37.2%) and the symptoms being mild (28.1%), followed by a reservation about the idea of hospital consultation itself (14.4%), lack of time (7.2%), and concerns about medical costs (5.6%). Menopausal symptoms were investigated using the MRS. When questioned about menopausal symptoms, sleep problems (28.0%), vaginal dryness (27.2%), joint or muscle discomfort (23.3%), and physical or mental fatigue were the most common severe or very severe symptoms experienced in the previous year (21.5%; Table 3 ). Significant differences were noted in the menopausal symptoms reported by perimenopausal and postmenopausal women. Perimenopausal women mostly reported physical or mental fatigue (29.6%), joint or muscle discomfort (29.1%), and sleep problems (26.2%), while postmenopausal women mostly reported vaginal dryness (28.8%), sleep problems (28.3%), and joint or muscle discomfort (22.2%). Among the 791 participants who experienced at least one severe menopausal symptom, 49.1% considered consuming health functional foods to alleviate their symptoms ( Table 4 ). In addition, exercise (34.4%), using no specific coping method (34.3%), and visiting the hospital (19.5%) were the other most common ways to manage symptoms.

In 2022, 3,098 female adolescents and adult women were surveyed about their menstrual health, of which 42.6% of adolescents reported severe menstrual pain and 46.1% of adult women reported severe premenstrual syndrome. Among 1,307 perimenopausal or postmenopausal women, 28.0% reported sleep problems and 23.3% reported joint or muscle discomfort. However, only 9.9% of adolescents and 28.5% of adult women with severe dysmenorrhea symptoms, as well as only 19.5% of women with severe menopausal symptoms, visited the hospital. Even if experiencing severe menstrual abnormalities, many individuals did not take any measures or relied on painkillers, as the intensity of symptoms decreased as the menstrual period progressed. Given that uterine lesions, such as endometriosis or uterine fibroids, can induce dysmenorrhea symptoms, it is crucial to determine the cause of menstrual problems through appropriate medical consultation and medical treatment [ 10 ]. Early diagnosis and treatment are particularly essential for dysmenorrhea symptoms in reproductive-age women, as delayed diagnosis of menstrual problems such as dysmenorrhea caused by reproductive system disorders may require invasive treatments, such as surgery. Participants who experienced severe dysmenorrhea symptoms were less likely to seek medical treatment, as they disliked the notion of gynecological consultation in general, lacked time, were worried about medical expenses, and worried about social perception. Therefore, further investigation is warranted into the underlying causes of women’s discomfort regarding gynecological visits and to provide support for adolescent and adult women to visit the hospital when necessary. Even among those experiencing severe menopausal symptoms, a higher proportion relied on consuming health functional foods (57.3% in perimenopausal women, 47.5% in postmenopausal women) or exercise (39.5% in perimenopausal women, 33.4% in postmenopausal women) than the proportion of those who visited the hospital for a consultation (15.3% in perimenopausal women, 20.2% in postmenopausal women). Despite the fact that menopause has a significant impact on women’s overall health after middle age, proactive treatment and management through medical consultations are not being adequately implemented. Given that menopause is a normal stage of life cycle and not a disease, perimenopausal women can experience sudden physical changes due to fluctuating hormone levels. Therefore, it is essential to recognize that menopausal symptoms are health issues that can be managed with appropriate intervention and to provide information about effective, evidence-based treatment, and management methods, so that women can cope with their symptoms and improve their quality of life[ 1 ]. Menstruation refers to regular bleeding experienced between menarche and menopause, and has an impact on women’s physical, mental, and social health [ 11 ]. Women menstruate for approximately 40 years of their lives; therefore, it is important to manage it appropriately to maintain a good quality of life from the beginning to the end of the menstrual cycle. In addition to ensuring access to necessary resources and menstruation products, it is crucial to ensure that women may maintain excellent health and fully engage in all aspects of life during the pre-, peri-, and post-menopausal stages. These resources include not only information, menstrual products, and supportive environment but also management of menstrual and menopausal symptoms and access to medical services to effectively resolve health problems. Several countries worldwide have emphasized the obligation to provide these resources from a human rights perspective [ 12 ]. This study has several limitations. First, the survey was conducted online due to the COVID-19 pandemic. Although efforts were made to express the survey questions clearly, taking into account the online survey method, it is difficult to exclude the possibility that the understanding of the survey questions by the respondents may have influenced their responses compared to face-to-face surveys. Second, we did not investigate the management of each symptom separately. Different types of symptoms may be managed differently; however, our findings do not provide more insights into this matter. Third, because the severity of dysmenorrhea and menopausal symptoms was self-reported, caution is required when comparing these results with those of previous surveys.