Many middle-aged women in their 40s and 50s come to the clinic with abnormal vaginal bleeding. Most of them think that they are suffering from menstrual disorders before they turn to menstruation and do not pay attention to it, thus delaying their condition. In fact, there are many common causes of vaginal bleeding in middle-aged women: 1. endometrial hyperplasia: endometrium is continuously affected by estrogen without progesterone antagonism, and different degrees of proliferative changes will lead to vaginal bleeding, divided into simple hyperplasia, complex hyperplasia and atypical hyperplasia, which are precancerous. 2.Endometrial cancer: It is a group of epithelial malignant tumors occurring in endometrium. The incidence has been on the rise for several years, and the main symptom is vaginal bleeding. 3. Endometrial polyp: a benign nodule protruding from the surface of the endometrium, mostly multiple, with symptoms such as increased menstrual flow and prolonged menstrual period. 4. submucosal fibroids: fibroids growing under the mucosa, even if they are small, may have symptoms such as increased menstrual flow and prolonged periods, and even lead to severe anemia. 5. Ovarian tumors: Ovarian tumors with estrogen secretion function can cause irregular vaginal bleeding, such as granulosa cell tumors and follicular membrane cell tumors. 6.Pregnancy: middle-aged women still have the possibility of pregnancy as long as they still ovulate. Pregnancy miscarriage or ectopic pregnancy can lead to vaginal bleeding, and even life-threatening if accompanied by intra-abdominal hemorrhage. 7.Age-related vaginitis: Declining ovarian function, lower estrogen level, vaginal wall atrophy, and reduced local resistance cause vaginal inflammation resulting in vaginal bleeding, which is usually less. 8.Cervical disease: mostly contact bleeding, which can be caused by cervicitis, cervical precancerous lesions or cervical cancer. 9. Dysfunctional uterine bleeding: bleeding caused by dysfunction of the hypothalamic-pituitary-ovarian axis. It is recommended that middle-aged women should have an annual gynecological examination, uterine adnexal ultrasound and cervical TCT examination. If abnormal vaginal bleeding occurs, do not simply treat it as a manifestation of menopause.