bdominal and vaginal examinations are normal. The haemo globin percentage is 9 g/dl and the platelet count is within the normal range. The transvaginal ultrasound scan is normal.

1. Cyclical treatment with oral contra ceptive pills for 3 months. 
2. Dilatation and curettage. 
3. Norethisterone 5 mg three times daily for 7 days during menstruation. 
4. Norethisterone 5 mg twice daily for 3 cycles of 21 days. 
5. Tranexamic acid 500 mg 8 hourly for 1 week during menstruation. 

Tranexamic acid 500 mg 8 hourly for 1 week during menstruation. 

Since this patient has heavy menstrual bleeding with regular 28-day cycles, without any structural lesions, tranexamic acid administered during each bleeding episode is the first line treatment, as it will reduce the blood loss. Cyclical treatment with norethisterone or OCP is also effective, but is not considered as the first line therapy, for heavy regular menstrual bleeding lesions, cyclical treatment is required. Dilatation and curettage is not necessary as she is under 40 years of age, has no risk factors for endometrial carcinoma and the transvaginal ultrasound scan is normal. 

https://www.nice.org.uk/guidance/ng88