A 42-year-old woman from Delhi presents with heavy menstrual bleeding for the past 8 months. She reports soaking 10–12 pads per day during menses, with clots the size of a coin. Her cycles are regular (28 days), but duration has increased from 5 to 7 days. She denies intermenstrual bleeding, postcoital bleeding, or pelvic pain. On examination, the uterus is uniformly enlarged, firm, and mobile. Pelvic ultrasound shows a 4 cm intramural fibroid in the fundus and normal endometrial thickness (8 mm). Hemoglobin is 9.2 g/dL. What is the most appropriate first-line medical management?