**Core Concept**
The patient presents with menorrhagia, which is characterized by abnormally heavy or prolonged menstrual bleeding. The underlying cause is likely related to hormonal imbalances, specifically anovulatory cycles or uterine fibroids, given her history of hypertension and parity.

**Why the Correct Answer is Right**
The patient's symptoms suggest that she may benefit from hormonal therapy, specifically a progestin-only regimen. This is because progestins can help regulate menstrual cycles, reduce bleeding, and provide endometrial protection. Given her history of hypertension, a progestin-only option is preferred over estrogen-containing therapies, which may exacerbate blood pressure.

**Why Each Wrong Option is Incorrect**
**Option A:** Mirena (levonorgestrel-releasing intrauterine system) would be an effective option, but it may not be suitable for a woman with hypertension, as it can increase blood pressure in some cases.
**Option B:** Combined oral contraceptives (COCs) would be a good choice, but they may not be suitable for a woman with hypertension, as they can increase blood pressure due to the estrogen component.
**Option C:** Tranexamic acid is a medication used to treat heavy menstrual bleeding but is not a first-line treatment for menorrhagia, especially in a woman with hypertension.
**Option D:** Uterine artery embolization may be an option for treating uterine fibroids, but it is a more invasive procedure and not typically the first line of treatment for menorrhagia.

**Clinical Pearl / High-Yield Fact**
When treating menorrhagia in a woman with hypertension, it's essential to choose a progestin-only option to avoid exacerbating blood pressure. This is a key consideration in managing patients with complex medical histories.

**Correct Answer: D. Progesterone-only therapy (e.g., medroxyprogesterone acetate)**