What are the recommended first-line treatment options for managing adenomyosis-related symptoms in women of reproductive age?

For women of reproductive age with suspected or diagnosed adenomyosis, the recommended first-line treatment option for managing heavy menstrual bleeding (HMB) symptoms is the **levonorgestrel-releasing intrauterine system (LNG-IUS)** NICE NG88. It is important to note that this is an off-label use for some LNG-IUSs NICE NG88. If a woman declines an LNG-IUS or it is not suitable, other pharmacological treatments can be considered NICE NG88. These include non-hormonal options such as **tranexamic acid** and **non-steroidal anti-inflammatory drugs (NSAIDs)** NICE NG88. Hormonal alternatives include **combined hormonal contraception** and **cyclical oral progestogens** NICE NG88. NSAIDs and some combined hormonal contraceptives are also used off-label for this indication NICE NG88.