The integration of Anaerobic ammonia oxidation (anammox) into the membrane bioreactor (MBR) process (AX-MBR) is proposed in this study to reduce operating costs. The temperature was not controlled during the study. Anammox, denitrification, and nitrification were studied in the AX-MBR for 210 days. The reactor was fed with mainstream sewage from Guilin City, China. The results showed that AX-MBR could run with reduced dissolved oxygen (DO) concentration, and COD, NH4+-N, and total nitrogen removal were maintained or improved. The microbial analysis results demonstrated that the added anammox sludge could survive in the AX-MBR, but the sludge microbial diversity decreased. Nitrospira, Candidatus Kuenenia, and Nitrosomonas dominated the anammox sludge. In a word, the AX-MBR developed in this study could treat mainstream sewage with the appropriate management, and the operation costs are expected to reduce by decreasing the amount of aeration.