About one-third of women report heavy menstrual bleeding at some time in their lives. Menstrual blood loss increases with age. Menorrhagia is usually defined as heavy but regular menstrual bleeding of over 80 ml/cycle. Complaints of menorrhagia are common. Several medical therapies are suitable for perimenopausal women with either regular or irregular heavy bleeding. The most effective is intrauterine levonorgestrel. Other options are oral progestogens, the combined oral contraceptive pill, tranexamic acid, mefenamic acid, danazol and gonadotrophin-releasing hormone (GnRH) analogues. Systematic reviews and randomized controlled trials are discussed.