Objective: To investigate the clinical effect of levonorgestrel releasing intrauterine system (LNGIUS) compared to medroxyprogesterone for treating perimenopausal abnormal uterine bleeding. Methods: From August 2014 to August 2016, 88 women with perimenopausal abnormal uterine bleeding in Baoji maternal and child health care Hospital of Shaanxi province were randomly divided into observation group and control group. Women in observation group were treated by LNGIUS inserted, and women in control group were treated by medroxyprogesterone acetate. The menstrual volume, menstruation time, endometrial thickness, hemoglobin (Hb) and hematocrit (Hct) of women were compared between the two groups before treatment and in 3, 6, and 12 months after treatment. And rates of adverse reactions of women in both groups were also analyzed. Results: The menstruation volume, menstrual period, endometrial thickness of women in both groups in 3, 6, 12 months after treatment were significant decreased than those of women before treatment (P< 0.05), and value of Hb and Hct had significant increased than those of women before treatment (P< 0.05). The total effective rate of women in observation group was 97.73%, which was significant higher than that of women (84.09%) in control group (P< 0.05). There was no any serious adverse reaction in both groups. Conclusion: LNGIUS sued for treating abnormal uterine bleeding of perimenopause women has better clinical effect than that of medroxyprogesterone acetate, which is worthy of promotion.