Objective: To compare the clinical efficacy of tranexamic acid, carboprost tromethamine combined with intrauterine balloon versus carboprost tromethamine combined with intrauterine balloon in the treatment of postpartum hemorrhage (PPH) and their effects on endometrial repair. Methods: Clinical data of 110 patients with PPH admitted to the Department of Obstetrics, Nanjing Gaochun People''s Hospital from January 2023 to January 2026 were retrospectively analyzed. The observation group (n=55) received carboprost tromethamine, tranexamic acid plus intrauterine balloon tamponade, while the control group (n=55) received carboprost tromethamine plus intrauterine balloon tamponade. The two groups were compared in terms of hemostatic efficacy (intraoperative blood loss, 2-hour and 24-hour postpartum blood loss, hemostasis time, and hemorrhage control rate), endometrial repair parameters (endometrial thickness at 42 days postpartum, lochia duration, and incidence of intrauterine adhesions), and adverse reactions. Results: The observation group demonstrated significantly lower intraoperative blood loss, 2-hour and 24-hour postpartum blood loss, and shorter hemostasis time compared with the control group (all P<0.05), along with a significantly higher hemorrhage control rate (P<0.05). At 42 days postpartum, the observation group showed significantly greater endometrial thickness (P<0.05), significantly shorter lochia duration (P<0.05), and a significantly lower incidence of intrauterine adhesions (P<0.05) relative to the control group. No statistically significant difference was observed in the overall incidence of adverse reactions between the two groups (P>0.05). Conclusion: Carboprost tromethamine, tranexamic acid combined with intrauterine balloon achieves superior hemostatic efficacy compared with carboprost tromethamine combined with intrauterine balloon in the management of PPH, as evidenced by greater reduction in blood loss, shorter hemostasis time, and higher hemorrhage control rate. Moreover, this regimen more effectively promotes postpartum endometrial repair and is associated with a lower incidence of intrauterine adhesions, with a favorable safety profile.