What are the recommended first-line treatments for managing menorrhagia in primary care?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MSt MRCGP.

Posted: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed

The recommended first-line treatment for menorrhagia in primary care is the levonorgestrel intrauterine system (LNG-IUS), especially for women with no identified pathology, fibroids less than 3 cm in diameter, or suspected or diagnosed adenomyosis .

If an LNG-IUS is declined or unsuitable, consider other pharmacological options such as tranexamic acid, nonsteroidal anti-inflammatory drugs (NSAIDs), combined hormonal contraception (CHC), or cyclical oral progestogens (norethisterone) .

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