OBJECTIVE To evaluate the clinical efficacy of Baogong zhixue granule combined with medroxyprogesterone acetate （MPA） in the treatment of perimenopausal abnormal uterine bleeding （AUB） （yin deficiency and blood heat syndrome）. METHODS A total of 146 patients with perimenopausal AUB （yin deficiency and blood heat syndrome） admitted to Hainan Modern Women and Children’s Hospital from March 2022 to February 2023 were prospectively enrolled and divided into control group （73 cases） and combined group （73 cases） by random number table method. The control group took MPA orally， 10 mg each time， twice a day； the combined group took Baogong zhixue granule on the basis of the control group， 15 g each time， 3 times a day. Both groups started taking the medicine from the 5th day of menstruation， and took the medicine for 22 days as a treatment cycle. Both groups were treated for 2 consecutive cycles and followed up for 12 months. The bleeding control time， complete hemostasis time， endometrial thickness， total effective rate， recurrence rate， traditional Chinese medicine syndrome score， sex hormone and inflammatory factor levels， and adverse reactions were compared between the two groups. RESULTS The bleeding control time and complete hemostasis time of the combined group after treatment were significantly shorter than those of the control group （P＜0.05）， and the scores of light-color menstrual blood or clots， lower abdominal pain， sallow complexion， and fatigue and shortness of breath were significantly lower than those of the control group （P＜0.05）. The total effective rates of the combined group at 1， 3， 6 and 12 months after treatment were significantly higher than those of the control group （P＜0.05）， and the overall recurrence rate within 12 months was significantly lower than that of the control group （P＜0.05）. Compared with before treatment， the endometrial thickness， the serum sex hormones （follicle stimulating hormone， estradiol， and luteinizing hormone）， and the inflammatory factors （interleukin-6， tumor necrosis factor-α） levels of the two groups after treatment were significantly reduced or decreased （P＜0.05）， and the reduction or decrease in the combined group was greater than the control group （P＜0.05）. There was no significant difference in the incidence of adverse drug reactions between the two groups （P＞0.05）. CONCLUSIONS Baogong zhixue granules combined with MPA are effective in treating perimenopausal AUB （yin deficiency and blood heat syndrome）. They can quickly stop bleeding， inhibit endometrial hyperplasia， and regulate the levels of serum sex hormones and inflammatory factors. They also have a low recurrence rate and high safety.