OBJECTIVES: To compare the cost-effectiveness of different therapies for the treatment of dysfunctional uterine bleeding (DUB) in Spain. METHODS: A decision-analytic model was built to estimate the clinical and economic consequences of initiating treatment for DUB with either levonorgestrel intrauterine system (LNG-IUS), combined oral contraceptives (COC), progestogens (PROG) or tranexamic acid (TRAX) and switching to COC (after failure with LNG-IUS or PROG) or to LNG-IUS (after failure of COC) or to a combination of both (50% to LNG-IUS and 50% to COC after failure with TRAX), whilst surgery (hysterectomy and endometrial resection) was assumed to be used as third line therapy in the base case.  Model probabilities were obtained from published systematic reviews and treatment pathways after initial failure and/or presence of adverse events (including pregnancy in women requiring contraception) where derived from expert opinion. Local data on health resources use and costs were used and validated by clinical experts. Effectiveness was measured as symptom-free months (SFM) and modelled up to 5 years. The analyses take the perspective of the National Health System, so excluding all costs not supported by the public system (i.e. COC acquisition costs). RESULTS: Preliminary results show that the higher efficacy of LNG-IUS translates to a gain of 0.3-3.42 SFM at 5 years. Whilst LNG-IUS shows a short-term higher cost than the other options, posterior savings derived from a lower surgery rate, due to a better control of DUB, yields to cost savings respect to PROG, COC and TRAX of €158.6, €179.6 and €270.7, respectively. Furthermore, if surgery is assumed to be the only second line option after first line failures, cost savings with LNG-IUS could be more than €400 after 5 years. CONCLUSIONS: Preliminary results of this study indicate that LNG-IUS is a dominant option with respect to COC, PROG or TRAX, with lower costs and higher effectiveness than these therapies.