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ORIGINAL ARTICLE Korean J Obstet Gynecol 2011;54(9):523-528 http://dx.doi.org/10.5468/kjog.2011.54.9.523 pissn 2233-5188 eissn 2233-5196 PREMENSTRUAL SYNDROME AND DYSMENORRHEA IN THE CAREER WOMEN AT BUCHEON CITY Tae-Hee Kim, MD, PhD, Hwang Shin Park, MD, Hae-Hyeog Lee, MD, PhD, Soo-Ho Chung, MD Department of Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea Objective We wanted to evaluate the prevalence of dysmenorrhea and premenstrual syndrome (PMS) among the career women of Bucheon City and their knowledge of and ability to seek treatment regarding their dysmenorrhea and premenstrual syndrome. Methods A questionnaire survey regarding premenstrual symptoms was conducted for 289 career women. The cycle of menstruation, the regularity, the amount of menstruation and the intensity of dysmenorrheal were assessed and the symptoms were classified according to their intensity and persistence. Women s awareness of PMS and the physician consultations were also evaluated. Results The approximate prevalence of PMS by the World Health Organization s International Classification of Disease (ICD-10) and the American College of Obstetrics and Gynecology criteria was 74% and 38%, respectively. The predominant symptoms of PMS were abdominal bloating, anger, weight gain, sleep disturbance, attention deficit, drowsiness, nausea and vomiting. PMS was significantly associated with the large amount of menstruation (P = 0.017) and there was no significant relation with the cycle, the severity of dysmenorrhea and the use of analgesics. Most of the women (94.1%) had no knowledge regarding the terminology pertaining to PMS and premenstrual dysphoric disorder. Conclusion PMS occurs frequently and it has a significant impact on the activity of career women. However, career women have little knowledge about PMS and they only infrequently consult their physicians. Physicians should educate and inform career women about PMS and this can help to increase the quality of life of these women. Keywords: Premenstrual syndromes; Premenstrual tension; Dysmenorrhea; Prevalence 가임기여성의 70-80% 는월경전에유방압통혹은복부팽만, 오심, 두통등의월경전징후 (premenstrual molimina) 들을경험한다 [1]. 일반적으로증상이경미하여특별한치료를요하지않는경우가대부분이나, 이중 20-40% 는월경전징후의정도가심하여일상생활에장애를받는다. 이를월경전증후군 (premenstrual syndrome, PMS) 이라고하며그증상으로는신체적증상뿐만아니라다양한정서증상들을포함한다 [1]. 국제질병분류 (International Classification of Disease, [ICD]-10) 에서정의한바로는경미한정신적장애 (minor psychological discomfort), 더부룩함 (bloating), 체중증가 (weight gain), 유방압통 (breast tenderness), 근육통 (muscular tension or aches), 집중력저하 (poor concentration), 식욕변화 (change in appetite) 의 7가지증상중 1가지이상만족시키면서이러한증상이월경주기중황체기에만국한될때월경전증후군으로진단할수있다고하였다 [2]. 특히우울감, 불안, 집중력저하, 짜증등 Received: 2011. 5.16. Revised: 2011. 6.27. Accepted: 2011. 7.29. Corresponding author: Hae-Hyeog Lee, MD, PhD Department of Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital, 1174 Jung 1-dong, Wonmi-gu, Bucheon 424-767, Korea Tel: +82-32-621-5378 Fax: +82-2-6008-6874 E-mail: hhl22@schmc.ac.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright 2011. Korean Society of Obstetrics and Gynecology WWW.KJOG.ORG 523

KJOG Vol. 54, No. 9, 2011 의정서증상이일상생활에심각한장애를초래할정도에이르게되면이를월경전불쾌장애 (premenstrual dysphoric disorder, PMDD) 라하며 2-8% 정도의빈도를보인다 [3,4]. 이기준에서는정신적증상을중요하게다루고있으며증상들이반드시일상생활을방해할정도의심한증상인경우여야만한다고하였다. 또한월경전불쾌장애는최소한 2회의월경주기동안매일증상들에대해점수 (daily prospective rating) 를주고그것을비교분석하여진단할수있다고하였다 [4]. 미국산부인과학회 (American College of Obstetrics and Gynecology, ACOG) 에서제시한진단기준에의하면다음의신체적, 감정적증상중한가지이상이월경전 5일동안, 이전 3회의월경주기에서나타나는경우이다 [5]. 단, 이러한증상은월경이시작된지 4일이내에사라지고적어도월경주기 13일째까지는다시발생하지않아야한다. 직장여성들이점점늘고있는현대에여성들이느끼는부담과스트레스는과거에비해현저하게증가되었다. 따라서, 육아이외에부가적인노동과스트레스에놓여진직장여성들에서월경전증후군과월경의특성이일반여성들과차이가있을것이라는가정을하고직장여성들에서유병률, 증상유무, 치료에대하여알아보고자한다. 경기도부천시에소재한 5개기업에서공개건강강좌에참석한 289명의가임기여성에게설문지를배부하여조사하였으며, 총 289부를회수하였다. 이중설문지에성실하게응답하지않은 60명과갑상선질환을비롯한내분비장애, 자궁내막증, 암, 전신성홍반성낭창, 빈혈, 감염등과같은기질적원인이있는 59명을제외하고총 170명을연구대상으로선정하였다. 해당기업의허락을받은후 289명의가임기여성들에설문조사방법을설명한후설문작성법을숙지시킨후본연구팀이직접개발한설문지를배부하였고, 직원들스스로가설문에응답하게한후회수하였다. 기본정보는여성의나이, 키, 몸무게를포함하였고, 월경에대한질문의내용은월경주기의규칙성, 월경지속기간, 월경의양, 월경전증후군의유무와양상그리고월경통의유무와양상, 각각에대한가족력이포함되었다. 조사한설문지자료를 SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA) 을이용하여분석하였다. 먼저월경전증후군정의에의한유병률을알아보았고, 대상자들의사회인구학적특성, 월경관련특성등과월경전증후군여부와의관련성은카이제곱검정으로평가하였다. 월경전증후군에영향을미치는변수를알아보기위하여월경전증후군여부를종속변수로하고단변량분석에서유의한관련이있었던변수를독립변수로 하여다변량로지스틱회귀분석을실시하였고, 교차비와 95% 신뢰구간을제시하여통계적유의성을판단하였다. 전체 289명의평균나이는 34.4 ± 7.5세였고, 평균체질량지수 (body mass index) 는 21.1 ± 3.6 kg/m 2 이었다. 이중기혼자는 171명 (59.2%), Table 1. Characteristics of career women group Variables Total = 170 Age (yr) 10 20 1 (0.6) 20 30 51 (30.0) 30 40 86 (50.6) 40 50 24 (14.1) 50 60 7 (4.1) Body mass index (kg/m 2 ) 18.2 22 (12.9) 18.3 22.6 98 (57.6) 22.7 24.7 18 (10.6) >24.7 15 (8.8) Status of marriage Single 73 (42.9) Married 96 (56.5) History of abortion Yes 35 (20.6) No 127 (74.7) Parity 0 54 (31.8) 1 113 (66.5) Values are presented as number (%). Table 2. Symptoms of premenstrual syndromes Symptoms Total = 170 Abdominal bloating 123 (72.4) Anger 105 (61.8) Change of weight (gain) 104 (59.8) Sleep disturbance 87 (51.2) Attention defi cit 82 (48.2) Drowsiness 58 (34.1) Nausea or vomiting 50 (29.4) Values are presented as number (%). 524 WWW.KJOG.ORG

Tae-Hee Kim, et al. Premenstrual syndrome and dysmenorrhea in the career women at Bucheon City Table 3. Characteristics related to menstruation and relevance with the premenstrual syndromes Premenstrual syndrome Yes No P value Cycles of menstruation Regular 142 (83.5) 102 (71.8) 40 (28.2) 0.125 Irregular 28 (16.5) 24 (85.7) 4 (14.3) Dysmenorrhea None 13 (7.6) 9 (69.2) 4 (30.8) 0.834 Mild 54 (31.8) 39 (72.2) 15 (27.8) Moderate 73 (42.9) 54 (74.0) 19 (26.0) Severe 30 (17.6) 24 (80.0) 6 (20.0) Taken analgesics None 80 (47.1) 58 (72.5) 22 (27.5) 0.385 Sometimes 59 (34.7) 42 (71.2) 17 (28.8) Monthly 31 (18.2) 26 (83.9) 5 (16.1) Amount of menstruation Normal 67 (39.4) 43 (64.2) 24 (35.8) 0.017 Menorrhagia 103 (60.6) 83 (80.6) 20 (19.4) Values are presented as number (%). Table 4. The result of multiple logistic regression analysis using premenstrual syndromes as dependent variables Variables Odds ratio 95% confidence interval Regularity of cycles (irregular/regular) 1.936 0.610 6.138 Dysmenorrhea 1 (mild/none) 1.118 0.282 4.443 Dysmenorrhea 2 (moderate/none) 1.184 0.292 4.807 Dysmenorrhea 3 (severe/none) 1.393 0.242 8.028 Analgesics 1 (monthly/sometimes) 1.416 0.382 5.251 Analgesics 2 (monthly/none) 0.739 0.317 1.721 Menorrhagia (menorrhagia/normal) 2.2 1.066 4.559 출산경험이있는여성은 174명 (60.2%) 이었다. 자료가불충분하거나, 갑상선기능이상등의다른원인질환배제후 170명을대상으로기본사항및월경전증후군의증상분포는 Tables 1, 2와같았으며, 많은증상의순서로는배부른느낌, 화혹은분노, 체중증가, 불면증, 집중력장애, 졸림, 오심과구토순이었다. 전체에서월경곤란증은 157명 (92%) 에서호소하였고, 월경전증후군의유병률은세계건강보건기구의 ICD-10 에의한기준으로 74%, ACOG의기준으로 38% 이었다. 평상시월경주기상태, 월경곤란증여부, 진통제복용여부, 월경양등월경관련특성과관련성을알아본결과, 월경주기, 월경곤란증여부, 진통제복용여부는통계적으로유의한관련성이없었지만, 월경양이정상인경우월경전증후군이 39.4% 인데비해과량인경우는 60.6% 로유의하게높았다 (Table 3). 월경전증후군유무를종속변수로다중로지스틱회귀분석을시행한결과에서도월경과다가월경전증후군과유의한관련성이있었다 (Table 4). 건강강좌전에월경전증후군에대해알고있는사람은 10명 (5.9%) 이었고, 강의와설문조사후에월경전증후군으로진단받은 126명의여성중 8명 (6.3%) 이의사와상담한경험이있었고, 102명 (81%) 이산부인과방문의필요성에대해긍정정인반응을보였다. 가임기여성의 70-80% 는월경전에유방압통혹은복부팽만, 오심, 두통등의월경전징후들을경험한다 [1]. 치료를요하지않는경우가대부분이나이중 20-40% 는월경전징후의정도가심하여일상생활에장애를받는다. 월경전증후군에대한정의는여러가지가있으며이를평가하는방법이나조사방법등도다양하며, 최근이를하나의질병으로여기고이에대한적극적인치료의필요성이제기되고있다 [2,3]. 증 WWW.KJOG.ORG 525

KJOG Vol. 54, No. 9, 2011 상은월경전황체기에나타나며월경이시작되면사라지기때문에환자들은한달에일주일이상동안관련증상으로고통을받는데질환의지속기간역시길고치료중단후재발률이높기때문에적절한치료법의선택뿐만아니라일상생활에서증상을관리하는것이매우중요하다. 실제로월경전증후군을가진여성들은일생동안거의 3,000일을고통과괴로움을경험하게된다. 월경전증후군에대한빈도는 20-95% 까지다양하게보고되고있다 [6]. 간호사및직원가족을대상으로전향적인방법으로 DSM-IV의월경전불쾌장애진단기준에따른유병률을조사한결과, 47.1% 로나타났다 [7,8]. 의학적관심을요할정도의심한증상은대부분의역학조사에서 3-10% 정도로보고되어왔다 [9]. 그러나이들연구는 DSM 진단기준에서요구하는전향적매일평가를실시한것이아니다. DSM-IV 진단기준을사용한두외국연구에서는월경전불쾌장애유병률이각각 3.4% 와 [10] 4.6% 로 [11] 나타났으며, 국내연구에서는 5% 와 [12] 4.6%[13] 로각각나타났다. 최근월경전증후군의유병률이증가함에따라청소년기여성의월경전증후군과 [14-16] 산부인과를방문한가임기여성들의월경증후군실태에 [17] 관한논문과여러치료관점에관한연구가진행되고있다. 월경전증후군 / 불쾌장애의유병률은대부분국외자료들을근거로언급되어왔는데이는국내연구가부족하였기때문이다. 가임여성을대상으로한국의월경전증후군 / 불쾌장애의유병률및일상생활에미치는영향과치료현황을파악하는실태조사가 2008년진행되었는데, 지역별, 연령별인구비례에따라무작위추출된 1,000명을조사한결과, ACOG 진단기준에의거하여 32.1% 여성에서월경전증후군을겪고있으며 ( 국제질병분류기준, 98.6%), 월경전불쾌장애는유병률이 2.8% 로조사되었다. 지난 2008년초에아시아태평양지역에서시행된동일한조사와비교해볼때아시아태평양 (Asia Pacific [AP], 호주, 홍콩, 태국, 파키스탄 ) 지역은월경전증후군의유병률이 22% 로국내보다다소낮았으며라틴아메리카, 유럽의경우는 37% 로비슷한수준을보였다. 월경전불쾌장애유병률은각각 4%, 3% 로타지역과큰차이는없었다. 관절, 근육및허리의통증, 복부통증, 가스가차고거북한느낌, 유방통등의신체증상을구체적으로많이경험하는것으로나타났다. 또짜증, 신경질, 피로, 무기력증, 화, 과식 / 식탐등은 50-60% 의여성들에서지난 3번의월경주기동안매번경험한것으로조사되었다. 한편월경전증후군 / 불쾌장애에대한인지도, 친숙도에있어서는월경전증후군과월경전불쾌장애가서로다른양상을보여주는데불쾌장애는인지도, 친숙도가 3%, 9% 로국외자료와큰차이를보이지않으나 (AP, 4%, 6%) 월경전증후군은각각 6%, 27% 로 AP 지역보다 (30%, 32%) 현저히낮게나타났다. 이와같이질환에대한낮은인지도 / 친숙도는환자들이병원을찾지않거나적절한치료를받고있지않을가능성을시사하기때문에질환에대한적극적인홍보및교육이필요할것으로생각된다 [18]. 월경전증후군을진단할수있는검사방법은확실하게정해져있지않다. 우선적으로는충분한병력청취와신체진찰이필요하고경우에따라혈액학적, 호르몬, 화학검사를시행할수있다. 정의와진단기준이매우다양하고환자의주관적인증상에의존하기때문에설문지와월 경일지를이용하여증상이나타나는기간과강도를자세하게기록해야만정확한진단을내릴수있다 [19]. 실제로월경전증상은빈번히발생하고많은여성의일상생활에영향을미치고있다. 월경전증상에대한인지정도는매우낮으며의사와의상담도드물게이루어지는실정이다 [20]. 이번설문조사대상자들중 5.9% 만이월경전증후군에대해인지를하고있었고, 후향적으로과거의기억에의존해연구에참여하였기때문에진단에한계가분명히있었다. 따라서좀더간단하고기억하기쉬운국제질병분류의기준을사용하였고 74% 의높은유병률을얻을수있었다. 이전에청소년이나대학생등을대상으로월경전증후군의유병률과그특징에관한보고가있었지만, 직장인을대상으로한연구는아직활발히이루어지지않았다. 여성들의사회참여가증가하였고, 여성들이느끼는부담과스트레스는과거에비해현저하게증가되었다. 따라서, 육아이외에하루에거의 8시간이상앉아서근무하는사무직여성직장인의부가적인노동과스트레스에놓여진직장여성들에서월경전증후군과월경의특성이다른그룹에비해높은유병률을보인것이라판단된다. 물론, 직장여성전체를대표하는모집단을추출한것이아니고표본의크기도작아일반화하기는어렵지만, 직장여성들은육아와일을동시에해야하는과중한업무, 승진등직장내스트레스, 경쟁적상황으로청소년기만큼예민할수있다. 따라서직장여성들의월경전증후군으로인한업무능률저하, 직장내대인관계문제등직장생활에큰장애를초래할만큼개인적, 사회적인악영향이심각할수있다. 직장여성들의월경전증상및증후군에대한유병률은높은반면, 그인지도는매우낮은상태로산부인과의사와상담을하는여성은드문상태였다. 따라서지속적인건강강좌와교육을통하여월경전증후군의정확한인식을유도하고, 효과적인의학적치료를받는다면직장여성의건강증진을도모할수있고만족도또한고취시킴으로써업무의효율성을극대화하는데실제로도움을줄수있을것으로판단된다. 경기도부천시일부회사의직장여성을대상으로실시한연구이므로전반적인직장여성을대표할수는없으며, 설문조사를통한조사이므로한계점이존재하나, 육아와과중한업무, 승진등직장내스트레스, 경쟁적상황등의예민한상황에대한직장여성들의노출에대한관심을가져야하며, 월경전증후군의교육에사회적인관심이필요하다. References 1. Reid RL, Yen SS. The premenstrual syndrome. Clin Obstet Gynecol 1983;26:710-8. 2. Janca A, Hiller W. ICD-10 checklists: a tool for clinicians use of the ICD-10 classifi cation of mental and behavioral disorders. Compr Psychiatry 1996;37:180-7. 3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-III-R. 3rd ed. Washington (DC): American Psychiatric Association; 1987. 4. American Psychiatric Association. Diagnostic and statistical 526 WWW.KJOG.ORG

Tae-Hee Kim, et al. Premenstrual syndrome and dysmenorrhea in the career women at Bucheon City manual of mental disorders: DSM-IV. 4th ed. Washington (DC): American Psychiatric Association; 1994. 5. American College of Obstetricians and Gynecologists. Premenstrual syndrome. In: ACOG Practice Bulletin No. 15. Washington (DC): American College of Obstetricians and Gynecologists; 2000. p.1-9. 6. Kim TH. Premenstrual syndrome. J Soonchunhyang Med Sci 2009;14:79-84. 7. Lee SH. Premenstrual syndrome & premenstrual dysphoric disorder. J Korean Acad Fam Med 2001;22:761-72. 8. Lew YM, Joe SH. Premenstrual symptom patterns and coping style in women with premenstrual change. J Korean Neuropsychiatr Assoc 2000;39:1061-71. 9. Steiner M, Pearlstein T. Premenstrual dysphoria and the serotonin system: pathophysiology and treatment. J Clin Psychiatry 2000;61 Suppl 12:17-21. 10. Haskett RF, De Longis A, Kessler RC. Premenstrual dysphoria: a community survey. In: Presented at the 140th Annual Meeting of the American Psychiatric Association; 1987 May 9 15; Chicago. Washington (DC): APA Press;1987. 11. Rivera-Tovar AD, Frank E. Late luteal phase dysphoric disorder in young women. Am J Psychiatry 1990;147:1634-6. 12. Jeong BS, Lee C, Lee JH, Seo MK, Han OS, Kim CY. Prevalence of premensttual syndrome and premenstrual dysphoric. J Korean Neuropsychiatr Assoc 2001;40:551-8. 13. Park YH, Jeong BS, Kim CY, Lee C. Prevalence of premenstrual dysphoric disorder and occupational function in a nurse group. J Korean Neuropsychiatr Assoc 2001;40:832-41. 14. Park JW, Kim JS, Lee KY, Park TJ, Kim SH. Factors associated with premenstrual syndrome in high school students. Korean J Fam Med 2009;30:710-6. 15. Kim J, Ryu SY. The prevalence of premenstrual syndrome and its related factors among high school girls. J Korean Soc Matern Child Health 2006;10:11-20. 16. Kim HO, Lim SW, Woo HY, Kim KH. Premenstrual syndrome and dysmenorrhea in Korean adolescent girls. Korean J Obstet Gynecol 2008;51:1322-9. 17. Park HE, Jee BC, Ku SY, Suh CS, Kim SH, Choi YM, et al. A survey on premenstrual syndrome. Korean J Obstet Gynecol 2005;48:401-140. 18. Choi DS. The diagnosis and management of premenstrual syndrome/premenstrual dysphoric disorder. In: The 41th training workshop for Korean Society of Obstetrics and Gynecology; 2009 May 22-23; Busan, Korea. Seoul: Korean Society of Obstetrics and Gynecology; 2009. p.135-46. 19. Lim H, Park Y. Differences in dietary intake and life-style of female college students in Seoul with and without premenstrual syndrome. J Korean Soc Menopause 2010;16:153-61. 20. Choi D, Lee DY, Lehert P, Lee IS, Kim SH, Dennerstein L. The impact of premenstrual symptoms on activities of daily life in Korean women. J Psychosom Obstet Gynaecol 2010;31:10-5. WWW.KJOG.ORG 527

KJOG Vol. 54, No. 9, 2011 부천지역직장여성의월경곤란증과월경전증후군실태조사 순천향대학교의과대학순천향대학교부천병원산부인과김태희, 박황신, 이해혁, 정수호 목적경기도부천시지역의직장여성들에서월경전증후군의유병률을알아보고, 월경전증후군에대한인지도와의료상담및치료의빈도를평가하기위함이다. 연구방법월경전증후군에대한공개강좌후설문지를통해 5개기업 289명의직장여성을대상으로조사를시행하였다. 그중답변이부족한경우나다른질환으로인한증상을배제한후 170명을대상으로월경주기, 규칙성, 월경곤란증의정도, 진통제복용여부, 월경전증상의빈도, 기간등을평가하였다. 건강강좌전월경전증후군에대한인지여부와상담유무도조사하였다. 결과월경전증후군의유병률은세계건강보건기구의 ICD-10에의한진단기준으로 74%, 미국산부인과학회의진단기준으로 38% 였다. 월경전증상은빈도순으로볼때더부룩함, 분노나화남, 체중증가, 잠을설침, 집중력장애, 졸림, 오심구토의순이었다. 월경전증후군은월경량이정상인군에비해과량인군에서유의하게증가되어있었고월경주기나월경곤란증의정도, 진통제복용등과는유의한상관관계를보이지않았다. 연구대상자의대부분인 94.1% 가월경전증후군에대해모르는상태였고, 6.3% 정도가의사와의상담한병력이있었다. 결론월경전증후군은매우흔하며특히직장여성들의직장에서의활동과업무에많은영향을끼치고있다. 그에반해, 대부분의직장여성들은월경전증상및월경전증후군에대해정확히인지하지못하는상태로의학적상담및치료도거의이루어지고있지않다. 따라서지속적인건강강좌와교육을통해월경전증후군에대해알리고효과적인의학적치료를유도한다면향후업무의효율성을높이고삶의질을높일것이라판단된다. 중심단어 : 월경전증후군, 월경전긴장, 월경곤란증, 유병률 528 WWW.KJOG.ORG