Purpose: To evaluate the current status of utilization and implementation of health promotion programs for Korean middle-aged women in public health centers. Methods: Three-phase stratified sampling was done to select 1304 middle-aged women (aged 40-64 years) from all regions of Korea. The data were collected by face-to-face interviews using a structured questionnaire for individual responses and mailed surveys to 126 public health centers. Descriptive statistics and $x^2$-test were done for data analysis. Results: Only 12 of the 126 public health centers (9.9%) implemented health promotion programs for middle-aged women, with the lack of manpower being cited as the main reason for the absence of programs. From individual responses, 11.3% had participated in health promotion programs offered by public health centers. The main reasons for not participating were inconvenient times and lack of information. Significant differences were found in the frequency of participation in programs, exercise programs and diabetes management according to the size of region. The majority of the respondents cited the need for medical services, followed by programs focused on stroke prevention and leisure time management. The responses on the willingness to participate followed a similar pattern. Conclusion: There are gaps between the utilization of health promotion programs by middle-aged women and what is offered by public health centers. The results of this study support the need to develop more health promotion programs focusing specifically on the needs of middle-aged women.