The causes of 49-year-old woman’s belly include physiological and pathological, pathological woman’s belly may be the symptomatic manifestation of certain diseases, such as ovarian cysts, ovarian fibroids, cortisolism and so on. 1. Physiological factors: the age range of female menopause is generally 45 to 55 years old, 49-year-old woman belly may be due to menopause endocrine disorders, ovarian function decline, metabolism slowed down, overeating, which caused the accumulation of abdominal fat, the appearance of a large stomach. 2. Pathological factors: (1) Ovarian cysts: women in general have a higher risk of developing ovarian cysts, and patients with larger cysts may experience lower abdominal discomfort, swelling and other sensations, and with the development of the disease, the cysts or swellings continue to increase in size, which can also lead to a gradual increase in the size of the abdomen. (2) Ovarian fibroma: mostly seen in middle-aged and old-aged women, when the size of fibroma increases, it can lead to abdominal enlargement and abdominal pain, and a small number of patients with coexisting peritoneal effusion will also have the symptom of abdominal enlargement, and some of the patients are accompanied by urinary frequency and urgency. (3) Hypercortisolism: the long-term excessive secretion of glucocorticoids leads to metabolic disorders and is accompanied by a variety of other hormonal secretion abnormalities. The main clinical manifestations of patients with centripetal obesity, refers to the head and face, abdominal fat deposition increase, but the limbs are normal or thin, can also be accompanied by hairy, menstrual disorders, full moon face. 49-year-old woman with a big belly, exclude physiological factors, should be timely consultation, please doctor to clarify the cause of the disease, if necessary, the corresponding treatment.