Zhuyang-Huazheng Formula for Preoperative Bleeding Control in Endometrial Polyp-Associated Abnormal Uterine Bleeding: A Retrospective Cohort Study.

Endometrial polyps (EPs) are a common structural cause of abnormal uterine bleeding (AUB) in premenopausal women, and short-term bleeding control before hysteroscopic polypectomy is clinically important. This single-center retrospective cohort study evaluated preoperative bleeding outcomes associated with Zhuyang-Huazheng Formula (ZHF), a hospital-formulated traditional Chinese medicine regimen, compared with tranexamic acid (TXA), and explored Ki-67/p53 expression profiles in polyp tissue. A total of 181 premenopausal women with EP-associated AUB treated between January 2022 and December 2024 were included; 87 received ZHF and 94 received TXA. The primary endpoint was change in Pictorial Blood Loss Assessment Chart (PBAC) score. Secondary outcomes included PBAC responder rate, hemoglobin improvement, time to clinical stability (TtCS), adverse events, and Ki-67/p53 expression in polyp and adjacent endometrial tissues. Baseline characteristics were comparable between groups. PBAC scores decreased significantly in both groups, from 210.70 ± 56.60 to 93.03 ± 27.56 with ZHF and from 221.04 ± 54.27 to 92.85 ± 29.56 with TXA. The absolute reduction in PBAC score was significantly greater with TXA than with ZHF (128.19 ± 34.11 vs. 117.67 ± 35.99; P = 0.045). No significant between-group differences were observed in PBAC responder rate, hemoglobin gain, TtCS, or adverse-event rate, and no serious adverse events occurred. Adjacent endometrial Ki-67 indices and p53 H-scores were similar between groups, whereas polyp tissue from the ZHF group showed lower Ki-67 indices and p53 H-scores. Higher polyp-to-adjacent biomarker ratios were associated with greater bleeding burden and longer TtCS. ZHF was associated with short-term improvement in preoperative bleeding among women with EP-associated AUB, although TXA produced a significantly greater reduction in PBAC score. Several secondary clinical outcomes did not differ significantly between groups. The lower polyp-tissue Ki-67 indices and p53 H-scores observed in the ZHF group are exploratory findings and should not be interpreted as evidence of treatment-induced biological modification.