Adenomyosis-Induced Heavy Bleeding and Anemia: An Integrated Chinese and Western Medicine Approach

Heavy menstrual flow, prolonged periods, fatigue, and anemia — these are the distressing symptoms many women with adenomyosis face. The excessive bleeding can't be ignored and requires a scientific, integrated treatment approach.

Combining Western medicine for quick hemostasis (to stop bleeding) with Traditional Chinese Medicine (TCM) for long-term regulation offers an effective solution — it stops the bleeding swiftly, treats the root cause, and helps preserve fertility.

The key principle is: address the symptoms urgently, and treat the underlying cause gradually — managing both the root and the surface together.

I. Western Medicine for Hemostasis: Fast, Precise, and Effective

When heavy menstrual bleeding begins to disrupt daily life, the top priority is to stop the bleeding quickly and prevent worsening anemia. Western medicine offers clear, targeted, and rapid solutions.

1. Hormonal Therapy – Regulating Hormones

Common medications: Dydrogesterone, medroxyprogesterone acetate, levonorgestrel, etc.

Mechanism: By supplementing progesterone, these drugs suppress excessive endometrial growth, reduce bleeding, and may even temporarily stop menstruation.

Best for: Women who wish to avoid surgery, still desire fertility, or have significant bleeding but not severe disease.

Note: Must be used under medical supervision with regular follow-ups to avoid long-term side effects.

2. Intrauterine Device (LNG-IUS, e.g., Mirena):

This IUD is not mainly for contraception, but rather continuously releases progesterone, acting directly on the uterine lining to make it thinner and reduce bleeding.

Many patients experience a transformation from “flood-like” bleeding to “light drizzle,” and some even stop menstruating after a few months — allowing the body to recover.

Advantages: Minimally invasive, reversible, and ideal for long-term management.

3. Hemostatic Medications:

Example: Tranexamic acid helps blood clot and rapidly reduces menstrual flow.

Usually taken a few days before menstruation and continued for 5–7 days, with excellent results.

Caution: Must be prescribed and monitored by a doctor to avoid risks such as thrombosis.

4. Surgical Treatments:

If medications fail, anemia worsens, or quality of life is severely affected, surgery may be considered.

Uterine artery embolization (UAE): A minimally invasive procedure that blocks the arteries supplying the uterus, reducing blood flow and shrinking lesions — highly effective for bleeding control.

Hysterectomy: The most definitive option for women without fertility needs and with severe, unmanageable symptoms.

The strength of Western medicine lies in its rapid effectiveness and clear therapeutic targets, making it particularly suitable for acute phases.

II. TCM Regulation: Strengthening the Root to Prevent Recurrent Bleeding

Western medicine acts quickly to stop bleeding, but TCM focuses on treating the root cause. In TCM theory, adenomyosis falls under the categories of “zheng jia” (abdominal masses) and “menorrhagia” (excessive menstruation). It is often associated with qi deficiency, blood heat, and blood stasis blocking the meridians. 

The guiding principle is: stop bleeding while resolving stasis, and replenish blood while regulating qi.

1. Internal Herbal Treatment – Syndrome Differentiation and Targeted Therapy

Qi deficiency type:

Symptoms: excessive but pale, thin menstrual blood, fatigue, weakness.

Common formulas: Ju Yuan Jian or Bu Zhong Yi Qi Tang (modified) — to tonify qi and secure blood.

Blood heat type:

Symptoms: bright red bleeding, heavy flow with clots, dry mouth, irritability.

Formula: Bao Yin Jian — clears heat, cools blood, and stops bleeding.

Blood stasis type:

Symptoms: dark, clotted menstrual blood with abdominal pain and tenderness.

Formula: Tao Hong Si Wu Tang (modified) — activates blood circulation, removes stasis, and restores normal flow.

2. Proprietary Chinese Medicines – Convenient and Effective Adjuncts

Gongxue Ning Capsules: cools blood and removes stasis; effective for menorrhagia.

Duanxueliu Tablets: promotes hemostasis; suitable for short-term use during excessive bleeding.

Bazhen Granules: used after bleeding decreases to replenish qi and blood, preventing anemia.

Fuyan Pill: clears heat, eliminates dampness, activates blood circulation, and regulates menstruation. Its main effect is improving the pelvic microenvironment and relieving chronic inflammation and qi-blood stagnation.

Particularly beneficial for adenomyosis patients outside the acute bleeding phase, especially those with pelvic pain, blood clots, prolonged menstruation, or excessive discharge. It helps unblock uterine stasis, regulate menstrual cycles, reduce bleeding duration and volume, and prevent recurrence.

Note: These patent medicines can be used alone or in combination based on individual constitution and symptoms, but should always be prescribed after TCM diagnosis to avoid inappropriate use.

III. Integrated Chinese and Western Medicine: Dual Approach, Double the Effectiveness

Relying solely on Western medicine may only address the symptoms, while relying only on TCM may not control acute bleeding. The combination of both offers the most balanced and effective strategy.

1. Acute Phase: Western Medicine as the Main, TCM as the Support

During heavy bleeding, use tranexamic acid plus progesterone to stop bleeding quickly.

At the same time, combine TCM hemostatic formulas (e.g., Duanxueliu Tablets or customized herbal decoctions) to enhance the hemostatic effect and stabilize the results.

2. Recovery Phase: TCM as the Main, Western Medicine as Maintenance

Once bleeding is under control, switch to tonic herbal prescriptions such as Bazhen Tang or Guipi Tang to replenish qi and blood.

Continue using the Mirena IUS or low-dose hormonal therapy to maintain hormonal balance and prevent recurrence.

3. Anemia Phase: Replenish Iron and Qi Together

Western medicine: Take oral iron supplements (e.g., ferrous sulfate) with vitamin C to improve absorption.

TCM: Use Danggui (Angelica sinensis), Huangqi (Astragalus), and Shudi (Rehmannia) to nourish blood and strengthen vitality; pair with dietary therapy such as Danggui–Ginger–Mutton Soup.

Dietary advice: Eat more red meat, spinach, and red dates; avoid tea and coffee as they hinder iron absorption.

IV. Lifestyle and Daily Care

Regardless of the treatment plan, healthy living habits are essential for long-term improvement.

Avoid overexertion: Rest more during bleeding periods; avoid staying up late or lifting heavy objects.

Eat light: Reduce spicy, raw, or blood-activating foods such as longan, brown sugar, and alcohol.

Manage emotions: Stress and anxiety can disrupt hormone balance; relaxation and emotional stability are vital.

Regular follow-ups: Have ultrasound and blood tests every 3–6 months to monitor uterine condition and anemia recovery.

V. Real Case Study

Emma, 38 years old, had suffered from adenomyosis for 5 years. Her menstrual periods lasted 8–10 days each cycle, with extremely heavy bleeding. Her hemoglobin dropped to 70 g/L (normal >110 g/L), indicating severe anemia.

Treatment Plan:

Acute phase:

Took tranexamic acid and dydrogesterone, which significantly reduced bleeding within 3 days.

Maintenance phase:

Inserted a Mirena IUS and combined it with Gongxue Ning Capsules to stabilize bleeding.

Recovery phase:

After bleeding stabilized, added Fuyan Pill to improve pelvic blood circulation and reduce stasis.

Took Bazhen Granules and beef stew with red dates to tonify qi and blood.

Complementary therapy:

Regular acupoint massage and moxibustion on Guanyuan (CV4) to warm meridians and support uterine health.

Results After 3 Months:

Menstrual duration shortened to 5 days.

Blood loss reduced by about 70%.

Hemoglobin rose to 105 g/L.

Complexion improved, and energy returned.

She said:

“I thought hysterectomy was my only option — I didn't expect that combining Chinese and Western medicine could really keep things stable!”

Conclusion

Acute bleeding: Use Western medicine for rapid control — don't delay.

Long-term management: TCM regulates constitution and reduces recurrence.

Anemia recovery: Combine iron supplements + Chinese herbs + nutrition for best results.

Lifestyle support: Rest, balanced diet, and emotional care are equally important.

Although adenomyosis can be stubborn, with integrated Chinese and Western treatment, scientific management, and consistent care, it's absolutely possible to normalize menstruation and restore vitality.