The common reasons for unclean menstruation at the age of 49 include perimenopause, endometrial cancer, cervical cancer, etc. Patients should go to the hospital in time to have a consultation and get a clear understanding of the cause of the disease and then have treatment for the cause of the disease.1. Perimenopause: after entering perimenopause, the function of the ovary gradually declines, which leads to the unstable change of hormone level in the body, and it may lead to the menstrual disorders, and there is the phenomenon of unclean menstruation, which is a normal physiological phenomenon and generally does not need special intervention. This is a normal physiological phenomenon and generally does not need special intervention; 2. Endometrial cancer: when endometrial cancer occurs, there will be irregular vaginal bleeding and incomplete menstruation, at this time, patients should go to the hospital in time for consultation, and after clear diagnosis, surgical treatment and radiotherapy can be carried out according to doctor’s instruction; 3. Cervical cancer: a small number of patients with cervical cancer may have prolonged menstruation and increased menstruation, which can be checked by cervical scraping cytology or HPV test, vaginal examination, or cervical examination, or by cervical examination. It can be clearly diagnosed by cervical scraping cytology or HPV test, colposcopy, etc. Generally, surgical treatment or radiotherapy should be applied, and middle and late-stage tumors can be combined with radiotherapy, chemotherapy, immune-targeted therapy to control the development of the disease; 4. Endometrial hyperplasia: patients with endometrial hyperplasia often have prolonged or shortened menstrual cycle, increased menstrual blood volume, irregular bleeding duration, etc., and they can be accompanied by pain in the lower abdomen. They can be treated with dextroprogesterone and medroxyprogesterone acetate as prescribed by the doctor, and total hysterectomy is needed if necessary. If menstruation is not complete, or accompanied by other uncomfortable symptoms, usually belongs to the abnormal situation, we need to improve the relevant examination in time to diagnose clearly, to avoid delaying the treatment to worsen the condition.