Journal of Psychosomatic Obstetrics & Gynecology

ISSN: 0167-482X (Print) 1743-8942 (Online) Journal homepage: http://www.tandfonline.com/loi/ipob20

Prevalence and related factors of irregular

menstrual cycles in Korean women: the 5th
Korean National Health and Nutrition Examination
Survey (KNHANES-V, 2010–2012)

Eun-Kyung Jung, Seok-Won Kim, Sun-Myeong Ock, Kyu-In Jung & Chan-Hee
Song

To cite this article: Eun-Kyung Jung, Seok-Won Kim, Sun-Myeong Ock, Kyu-In Jung & Chan-Hee
Song (2017): Prevalence and related factors of irregular menstrual cycles in Korean women: the 5th
Korean National Health and Nutrition Examination Survey (KNHANES-V, 2010–2012), Journal of
Psychosomatic Obstetrics & Gynecology, DOI: 10.1080/0167482X.2017.1321631

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Published online: 04 May 2017.

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JOURNAL OF PSYCHOSOMATIC OBSTETRICS & GYNECOLOGY, 2017
https://doi.org/10.1080/0167482X.2017.1321631

ORIGINAL ARTICLE

Prevalence and related factors of irregular menstrual cycles in Korean

women: the 5th Korean National Health and Nutrition Examination Survey
(KNHANES-V, 2010–2012)
Eun-Kyung Junga, Seok-Won Kima, Sun-Myeong Ocka, Kyu-In Jungb and Chan-Hee Songa
a
Department of Family Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; bDepartment of
Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

ABSTRACT ARTICLE HISTORY

Introduction: There have been few population-based studies reporting medical, lifestyle and Received 21 June 2016
psychological factors associated with irregular menstrual cycles. This study aimed to elucidate Revised 6 April 2017
the prevalence and related factors of irregular menstrual cycles in Korean women. Accepted 16 April 2017
Methods: Cross-sectional data from the 5th Korean National Health and Nutrition Examination
Survey were used. Eligible women were 19–40 years old, not currently taking oral contraceptives KEYWORDS
or using intrauterine devices, and not currently pregnant or breast feeding, and had no medical Depression; irregular
history of hysterectomy, thyroid diseases, cancers or renal failure. Finally, 3194 premenopausal menstruation; mental
women were recruited in this study. The prevalence and related factors of irregular cycles were health; prevalence; stress
obtained using a general linear model and logistic regression analyses in a complex sampling
design.
Results: The prevalence of irregular cycles was 14.3%. Age and high-education level were associ-
ated with lower odds ratios (ORs) for irregular cycles (OR 0.91, 95% confidence interval (95% CI)
0.87–0.96, and OR 0.58, 95% CI 0.38–0.88, respectively). The ORs of body mass index, perceived
stress and depressive mood were 1.05 (95% CI 1.01–1.10), 1.46 (95% CI 1.11–1.92) and 2.07 (95%
CI 1.18–3.63), respectively.
Conclusions: Age, perceived stress, body mass index, depressive mood and education level,
rather than obstetric factors or metabolic diseases were significant factors associated with irregu-
lar menstrual cycles in Korean women. Of these factors, perceived stress is the most significant
factor associated with increased irregular menstrual cycles.

Introduction stress, which itself indicates the importance of mental

Menstrual cycle regularity is considered an important
factor for women’s health. A regular menstrual cycle
indicates a normal sex hormone profile and reproduct-
ive organ functioning, whereas irregular cycles with
abnormal variations in length of menstrual periods
imply insufficient or dysfunctional sex hormones.
Previous studies have suggested that irregular men-
strual cycles were associated with obesity [1], polycys-
tic ovary syndrome [2], preeclampsia [3], low birth
weight [3] and various chronic diseases [4–7]. In add-
ition, psychological problems, such as stress [8,9] or
depression [10] can also result in dysfunction of the
normal menstrual cycle. A recent study reported the
association between dispositional resilience and regu-
lar menstrual cycles and suggested that dispositional
resilience could be a potential protective factor for
irregular menstrual cycles resulting from psychological
health on menstrual cycles [11].
Psychobiological studies demonstrated that psycho-
logical stress affects the hypothalamic-pituitary-
gonadal (HPG) axis, leading to disruption in proper
secretion of ovarian hormones and irregular menstru-
ation. Chronic anovulatory cycles with low levels of
sex hormones seem to be associated with various
metabolic diseases [12–14]. According to these studies,
we can infer that the HPG axis and ovarian function
are very susceptible to psychological stress.
A previous study reported that the prevalence of
irregular menstrual cycle was 11% in 3440 primiparous
Danish women [3], whereas none have been reported
to date for Korean women based on a population-
based survey. However, the prevalence of irregular
menstrual cycle in Korean women of childbearing age
should be similar or higher, because the number of

CONTACT Chan Hee Song chsong@catholic.ac.kr Department of Family Medicine, Yeoeuido St. Mary’s Hospital, Catholic University of Medical
College, 10, 63-ro, Yeongdeungpo-gu, Seoul 07345, Republic of Korea
ß 2017 Informa UK Limited, trading as Taylor & Francis Group
2 E. K. JUNG ET AL.

Koreans with chronic diseases, obesity, infertility and
psychological problems has increased rapidly, due in
part to the Westernization of dietary habits and highly
stressful social environments during the past few
decades.
To our knowledge, there have been few popula-
tion-based studies that evaluate the association
between these factors – lifestyle, medical, obstetric,
marital and psychological factors – and irregular men-
strual cycles. Most previous studies had limited study
population or focused on one side of medical disor-
ders or psychological problems. Therefore, this study
was performed to elucidate the prevalence and the
lifestyle, medical, obstetric, marital and psychological
factors associated with irregular menstrual cycles in
Korean adult women, using the 5th Korean National
Health and Nutrition Examination Survey (KNHANES)
data, which represents the health and nutritional sta-
tus of all Koreans.
Methods
Subjects
The KNHANES is a population-based and cross-sectional
survey on the health and nutritional status of Korean
people, which is planned and performed by the Korean
Centers for Disease Control and Prevention at 3-year
intervals [15]. Participants are selected by a stratified,
multi-stage cluster probability sampling design to
obtain nationally representative samples [15].
The design of this study was approved by the insti-
tutional review board (IRB) of the Korean Centers for
Disease Control and Prevention (IRB: 2010–02CON-21-
C, 2011–02CON-06-C and 2012–01EXP-01–2 C). Before
participating in the KNHANES, all participants gave
their own written informed consent. For this study, we
used data from the KNHANES V (2010–2012) including
11,109 Korean adult women aged 19 years and older.
To evaluate the factors associated with irregular
menstrual cycles, data from women aged 19–40 years
who were not pregnant or breastfeeding, not using
birth control pills or intrauterine devices at that time,
and did not undergo hysterectomy or oophorectomy,
were included. Women with primary or secondary
amenorrhea, thyroid diseases, chronic renal failure or
cancers were excluded from this study. In addition,
participants who did not take their physical examin-
ation or did not complete the answers to the ques-
tionnaires were also excluded. Following application of
these inclusion and exclusion criteria, among 3350
women aged 19–40 years, 3194 women (95.3%) were
finally eligible and participated in this study.
Socio-demographic and health examination
survey
Trained interviewers administered questionnaires
about the participants’ socio-demographic factors, life
styles and medical history. Examiners performed phys-
ical examinations at the participants’ homes or at
mobile examination centers. Socioeconomic status,
such as education level, household income and
employment status of all participants were classified.
Education level was categorized into two groups
according to the existence of a college degree. The
household income was categorized as the monthly
equivalized household income, estimated by standard-
ization methods for classifications based on the
national standard income level. Quartiles of the
adjusted family income were used in the analyses [16].
Height and weight were assessed by trained exam-
iners using standardized techniques and equipment.
Height and weight were measured with a portable sta-
diometer (Seriter, Bismarck, ND) and a Giant-150 N cali-
brated balance-beam scale (Hana, Seoul, Korea),
respectively. Body mass index was calculated as each
participants weight (kg) divided by height squared (m2).
Regular exercise was defined as high-intensity exer-
cise
20 min and
3/week, or moderate intensity
exercise
30 min and
 5/week, or walking
30 min
and
5/week. Frequencies of alcohol consumption
per month, smoking status, average sleep hours per
day, stress perception and depressive mood were also
included as factors possibly associated with menstrual
cycle regularities.
Measurements of perceived stress and depressive
mood
Questions about perceived stress and depressive mood
were asked by trained interviewers. Stress was meas-
ured by one question with four possible responses:
almost never, controllable, stressful or uncontrollable.
We converted this to a Likert scale of 1–4: “almost
never”¼1, “controllable”¼2, “stressful”¼3 and
“uncontrollable”¼4. Perception of depressive mood
was estimated through responses to the question,
“During the recent 12 months, have you ever felt sad or
hopeless almost every day for more than 2 weeks in a
row, which kept you from doing some usual activities?”
This question could be answered with either “yes”
or “no”.
Definition of irregular menstrual cycles
Menstruation without any periodic cycle was defined
as irregular menstruation. Menstrual cycle regularity

was evaluated from the following question that was
asked by trained interviewers: “do you have regular
menstruation with a certain periodic cycle on a
monthly basis?” Responders who answered “no” were
defined as having irregular menstrual cycles. If partici-
pants answered “yes”, they were classified as having
regular cycles.
Statistical analysis
The data were analyzed using the SPSS Statistics ver-
sion 21.0 (IBM, Armonk, NY). Since data in this study
were from a nationally representative survey, we used
a complex sampling design including strata, clusters
and weights. The sample weights from the KNHANES
were applied in all analyses.
Study participants were divided into two groups
according to menstrual cycle regularity: women with
regular menstrual cycles and women with irregular
menstrual cycles. Potential variables associated with
menstrual regularity were selected from previous stud-
ies. Mental health including stress and depression,
obstetric factors, such as age at menarche, number of
birth, age at first and last birth, duration of breast
feeding, medical history of chronic diseases, and life
style and socio-demographic factors were included in
analyses. Age and age-adjusted variables were com-
pared between the two groups, and expressed as
means ± standard errors (SEs) or as percentages using
general linear models.
Age, age of first birth, body mass index, perceived
stress, current smoking, education level, medical his-
tory of diabetes and depressive disorder, and depres-
sive mood for more than 2 weeks showed significant
or borderline significant differences between the two
groups by menstrual cycle regularities in the general
linear models (p < 0.1). To evaluate the independent
association of those variables with irregular menstrual
cycles (irregular menstrual cycles: yes ¼1, no ¼0),
odds ratios (ORs) with 95% confidence intervals (95%
CI) were calculated by multiple logistic regression anal-
yses examining full interactions of all those variables.
A p value <0.05 was considered to indicate statistical
significance.
Results
General characteristics of study participants by
menstrual cycle regularities
The weighted prevalence of irregular menstrual cycle
among Korean adult women aged 19–40 years was
14.3%. The mean age of women with regular and
JOURNAL OF PSYCHOSOMATIC OBSTETRICS & GYNECOLOGY 3
irregular menstrual cycles was 30.57 ± 0.17 and
27.65 ± 0.35 years, respectively (p < 0.001). Women with
irregular menstrual cycles had significantly higher BMI
and perceived stress compared to those with regular
menstrual cycles (p < 0.001) (Table 1).
Women with irregular menstrual cycles smoked
more (18.4 versus 8.4%) and had higher rates of med-
ical histories of diabetes (3.1 versus 1.0%), depressive
disorder (22.1 versus 15.6%) and depressive mood
(20.4 versus 14.0%) than women with regular men-
strual cycles. In contrast, the rates of participants with
a college degree or higher were 52.1% for women
with regular cycles, and 41.4% for women with irregu-
lar cycles (p < 0.05).
Marital and obstetric characteristics of study
participants by menstrual cycle regularities
There were no significant differences in age at menar-
che, number of birth, age of first and last birth, dur-
ation of breast-feeding and marital status between
women with regular and irregular menstrual cycles.
Age at first birth for women with regular and irregular
menstrual cycles was 27.02 ± 0.10 and 26.35 ±
0.35 years, respectively; the difference had borderline
significance (p ¼ 0.059) (Table 2).
Factors associated with irregular menstrual cycle
Multiple logistic regression analyses showed that age,
body mass index, perceived stress, education level and
depressive mood were significantly associated with
irregular menstrual cycles. Age and education level of
college degree or higher were significantly associated
with lower ORs for irregular menstrual cycles (OR 0.91,
95% confidence interval (CI) 0.87–0.96, and OR 0.58,
95% CI 0.38–0.88, respectively). However, body mass
index, perceived stress and depressive moods had
higher ORs for irregular menstrual cycles. ORs of body
mass index, perceived stress and depressive moods
were 1.05 (95% CI 1.01–1.10), 1.46 (95% CI 1.11–1.92)
and 2.07 (95% CI 1.18–3.63), respectively (Table 3).
Age at first birth, current smoking and medical his-
tory of diabetes and depressive disorder had no sig-
nificant associations with irregular menstrual cycles
(p > 0.1).
Discussion
In this population-based cross-sectional study of
Korean adult women, age, body mass index, perceived
stress, education level and depressive mood were sig-
nificantly associated with irregular menstrual cycles.
4 E. K. JUNG ET AL.

Table 1. Weighted and age-adjusted general characteristics of study participants according to menstrual cycle
regularity.
Regular cycle (N ¼ 2790) Irregular cycle (N ¼ 404)
Population size (%) 18,620,137 (85.7) 3,119,258 (14.3)
Variable Mean ± SEa Mean ± SEa p
Age (year) 30.57 ± 0.17 27.65 ± 0.35 <0.001
Body mass index (kg/m2) 21.82 ± 0.10 23.21 ± 0.25 <0.001
Alcohol consumption (frequency/month) 3.19 ± 0.05 3.27 ± 0.11 0.523
Perceived stressb 2.31 ± 0.02 2.50 ± 0.04 <0.001
Average sleep hours per day 7.22 ± 0.04 7.14 ± 0.10 0.419
Average working hours per week 25.54 ± 0.56 25.29 ± 1.30 0.855
% % p
Current smokers 8.4 14.8 0.003
Regular exercisec 47.2 47.7 0.886
Education college
Degree or higher 52.1 41.4 0.002
The employed 52.7 47.8 0.134
Quartile of monthly household income
Upper 28.1 32.9 0.120
Middle-high 34.7 34.0 0.818
Middle-low 29.2 26.5 0.359
Low 8.0 6.6 0.448
Medical history
Hypertension 2.2 2.8 0.432
Diabetes 1.0 3.1 0.074
Hyperlipidemia 7.1 10.4 0.105
Medical history depressive disorder 15.6 22.1 0.011
Perception of depressive mood
2 weeks 13.0 20.4 0.004
a
Mean ± SE or % by complex samples: general linear model adjusting for age.
b
Likert scale of 1–4, with 4 being the worst.
c
High-intensity exercise
20 min and
3/week, or moderate intensity exercise
30 min and
 5/week, or walking
30 min
and
5/week.

Table 2. Weighted and age-adjusted marital and obstetric characteristics of study participants
according to menstrual cycle regularity.
Regular cycle (N ¼ 2790) Irregular cycle (N ¼ 404)
Population size (%) 18,620,137 (85.7) 3,119,258 (14.3)
Variable Mean ± SEa Mean ± SEa p
Age at menarche (years) 14.53 ± 0.68 16.55 ± 2.37 0.411
Number of birth 1.48 ± 0.01 1.54 ± 0.05 0.274
Age of first birth 27.02 ± 0.10 26.35 ± 0.35 0.059
Age of last birth 29.44 ± 0.10 29.17 ± 0.31 0.399
Duration of breast feeding (month) 6.43 ± 0.23 6.09 ± 0.68 0.628
% % p
Marital status
Unmarried 33.3 33.0 0.912
Married 64.1 62.4 0.535
Separation 0.4 0.5 0.699
Bereavement 0.5 0.6 0.757
Divorce 1.8 3.5 0.145
a
Mean ± SE or % for complex samples: general linear model adjusting for age.

The prevalence of irregular menstrual cycles was
14.3% from the weighted-population data, which
was higher, compared with that reported previously
11% [3].
Increasing age and education level of college
degree or higher showed decreased ORs for irregular
menstrual cycles, whereas higher BMI, perceived stress
and depressive mood were associated with increasing
ORs for irregular menstrual cycles. Among these fac-
tors, increasing age was the most protective factor for
irregular menstrual cycles, whereas perceived stress
was the most significant factor associated with
increased irregular menstrual cycles.
These results were consistent with previous reports.
One study showed that a high-stress level was associ-
ated with menstrual irregularities in undergraduate
medical students [9]. A recent study also reported a
link between psychosocial stress and irregular men-
strual cycles and a protective effect of dispositional
resilience on irregular menstrual cycles resulting from
psychosocial stress [11].
Others reported that the prevalence of an irregular
cycle decreased with age [2,17]. However, another
study of 2016 nulliparous women aged 18–40 sug-
gested that increasing age was associated with irregu-
lar menstrual patterns [18]. Depression [10] and BMI

Table 3. Factors associated with irregular menstrual cycles.
Variable
Age (years)
Age of first birth
Body mass index (kg/m2)
Perceived stressa
Current smokers
Education
College degree or higher
Medical history of diabetes
Medical history of depressive disorder
Perception of depressive mood
2 weeks
By multiple logistic regression analysis in the full interaction model.
a
Likert scale of 1–4, with 4 being the worst.
b
Odds ratio for 1 point increase.
[17,18] were also considered significant factors for
irregular menstrual cycles in previous studies.
A population-based study reported that older
menarcheal age was associated with irregular menstrual
cycles [18,19]. They suggested that biological feedback
systems and mechanisms regulating menstrual cycles
are sensitized prior to reaching puberty and in turn,
contribute to both menarcheal age and mature men-
strual cycles [18,19]. In contrast, age at menarche was
not a significant factor for menstrual cycle regularities in
our study, which suggests potential ethnic differences.
A previous study also indicated potential ethnic differ-
ences of menstrual cycle characteristics between
African-American and European-American girls [20].
The results on associations between smoking and
menstrual cycles were also inconsistent. Although some
previous studies reported increased menstrual cycle
irregularity among smokers [17], smoking was not sig-
nificantly associated with menstrual cycle regularities in
our study. The percentage of current smokers was sig-
nificantly higher in women with irregular menstrual
cycles compared to those with regular menstrual cycles
in the analysis adjusting only for age, but this signifi-
cance disappeared in the multiple logistic regression
analysis including other confounding factors. Therefore,
these inconsistent results of previous and our studies
might be due to the diversity of study participants char-
acteristics and the variables included in analyses.
The frequency of alcohol consumption was not a
significant factor associated with menstrual cycle regu-
larities in our study, which is in agreement with a
report of no significant associations between alcohol
intake and menstrual cycle function [21]. In contrast,
other previous study reported that alcohol consump-
tion was linked to increased abnormal menstrual pat-
terns [17].
In this study, education level was significantly
related with menstrual cycle regularities. Women with
a college degree or higher had a decreased odds ratio
JOURNAL OF PSYCHOSOMATIC OBSTETRICS & GYNECOLOGY 5
Irregular menstrual cycles
Odds ratio (95% confidence interval) p
0.91 (0.87–0.96) <0.001
0.97 (0.92–1.04) 0.401
1.05 (1.01–1.10) 0.039
1.46 (1.11–1.92)b 0.007
0.80 (0.36–1.76) 0.572
0.58 (0.38–0.88) 0.010
2.08 (0.81–5.31) 0.125
0.82 (0.51–1.34) 0.435
2.07 (1.18–3.63) 0.012
for irregular menstrual cycles, whereas household
income and employment status were not significantly
associated. We assume that women with a higher edu-
cation level were more likely to have a supportive
familial environment, which might have favorable
effects on their physical and psychological health.
In our study, diabetes had no significant association
with increased ORs for irregular cycles in multiple
logistic regression analysis. However, previous studies
reported that diabetes was significantly associated
with increased ORs for menstrual irregularities [4,7].
This discrepancy might be due to the low prevalence
of diabetes in our study participants and the different
characteristics of Korean diabetic patients; a large
number of Korean diabetic patients have a normal
body weight, in contrast to Caucasians in Western
countries [22]. We infer that chronic irregular menstru-
ations accompanied by anovulatory cycles with defi-
cient levels of sex hormones contribute to the
development of various metabolic diseases [12–14].
These metabolic diseases may be the result of irregular
menstruation, not the cause, which is likely to produce
different associations between them depending on the
severity or duration of anovulatory cycles.
Among the factors included in our study, older age
exerted the greatest protection against menstrual cycle
irregularities in women of childbearing age. Regardless
of age at menarche, aging itself seems to mature and
stabilize the function of sex hormones and reproductive
organs. In contrast, perceived stress was most strongly
associated with irregular menstrual cycles. Depressive
mood was also significantly associated with irregular
menstrual cycles in our study. However, medical diag-
nosis of depressive disorder showed no significant asso-
ciation with irregular menstrual cycles, possibly due to
underestimating medical depression and the reluctance
of Koreans to express their depressed mood and visit
psychiatric departments. Depressive disorder is com-
monly underdiagnosed in primary care practice [23].
6 E. K. JUNG ET AL.
These findings are consistent with a previous report that
menstrual irregularity was associated with scores on
depression scales, but not with a recent psychiatric diag-
nosis of depressive disorder [10].
Although irregular menstrual cycles are associated
with the risk of various chronic diseases [4–7] and even
minor menstrual irregularities have an increased risk of
preeclampsia and low birth weight [3], the underlying
biological mechanisms regulating menstrual cycle pat-
terns are unclear. The variable length of the follicular
phase is mainly responsible for differences in cycle
length, and the length of follicular phase is determined
by follicular maturation and selection of the primary fol-
licle. These processes need follicular-stimulating hor-
mone released from the pituitary gland and an
appropriate ovarian response [24]. Higher variability of
cycle lengths is more likely to be associated with
anovulatory menstrual cycles [4]. In addition, exposure
to stress stimulates the hypothalamic–pituitary–adreno-
cortical (HPA) axis and connected neurochemical reac-
tions, following glucocorticoid release from the adrenal
glands. However, chronic activation of the HPA axis by
stress could inhibit sex hormone secretion, resulting in
irregular menstrual cycles [9,24].
This study has several weaknesses. First, it was of
a cross-sectional design, so a causal relationship
between factors and irregular menstrual cycles could
not be established. It is possible that perceived stress
and depressive mood could result from irregular men-
struation. Second, this survey did not include endo-
crine function tests affecting menstrual cycles, such as
thyroid hormones, and did not determine whether
women had undergone medical examinations to
evaluate the causes of menstrual problems. Therefore,
we are unable to completely exclude potential detec-
tion bias for explanation. We could assume that
women with irregular menstrual cycles are more likely
to have had a thyroid function test. Third, there were
only limited data on the menstrual features based on
individuals answers to one question about menstrual
regularity without medical diagnosis, which might
include potential recall bias and misclassification.
However, most of previous studies on menstrual cycles
also used self-reported questionnaires. In the Nurses’
Health Study II, self-reported irregular menstruation
was validated and the prevalence of irregular men-
strual cycles showed high concordance with other
studies [25,26]. Another study reported that the med-
ical history on the menstrual regularity of the patient
in the clinical interview corresponds to presence or
absence of ovulation [27]. And we assessed stress only
as a concept using the Likert scale, rather than bio-
markers, such as salivary cortisol [28].
Despite these weaknesses, our study also has several
strengths. This is a population-based study from
a nationally representative survey including socio-
demographic, medical, obstetric, lifestyle and psycho-
logical factors, whereas many previous studies had a
limited study population or included only one side of
either medical or psychological factors. And, questions
on mental health, menstrual regularities and socio-
demographic factors were asked by the interviewers
who had completed official training programs for this
survey and were verified by the Korean government. In
addition, we definitely observed that mental health sta-
tus, such as perceived stress and depressive mood,
rather than obstetric factors or metabolic diseases, are
more closely associated with irregular menstrual cycles
in Korean women.
In conclusion, our results show that perceived stress
is the most significant factor associated with increased
irregular menstrual cycles. Our study also suggests
that older age and higher education level seem to be
protective factors against irregular menstrual cycles,
whereas depressive mood and higher body mass index
are associated with irregular menstrual cycles.
Therefore, physicians may need to pay more attention
to mental health when they care for patients with
irregular menstrual cycles. Further prospective studies
should elucidate causal relationships between medical,
psychological, socio-demographic and life-style factors
and menstrual cycle regularity.
Interpretation
The results of this study show that perceived stress is
the most significant factor associated with increased
irregular menstrual cycles. Mental health status, such
as perceived stress and depressive mood, rather than
obstetric factors or metabolic diseases, seems to be
more important factors affecting irregular menstrual
cycles in Korean women.
Disclosure statement
The authors report that there are no conflicts of interest.
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ä Current knowledge on the subject.

 Previous studies have suggested that irregular menstrual cycles were associated with obesity and various chronic diseases.
 Psychological problems, such as stress or depression could also result in dysfunction of the normal menstrual cycle.
 Some results on age, life style, metabolic diseases, obesity, obstetric and gynecologic factors were inconsistent.

ä What this study adds.

 The prevalence of irregular menstrual cycles was 14.3% in Korean adult women.
 Analyses examining full interactions of possible significant factors suggested that younger age, higher body mass index, perceived stress and
depressive mood were associated with irregular menstrual cycles.
 Mental health, such as perceived stress and depressive mood, rather than metabolic diseases was a more important factor associated with irregu-
lar menstrual cycles in this study.