OBJECTIVES: To describe the resource utilization and the costs related to heavy menstrual bleeding (HMB) control with either an LNG-IUS or hysterectomy in the Brazilian Public Health System (SUS) on patients treated at the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Brazil.  METHODS: we performed an observational retrospective descriptive study with costs evaluation and budgetary impact calculation from data extracted from medical files of patients diagnosed with HMB treated either with the LNG-IUS or hysterectomy. The measured outcomes were HMB control, LNG-IUS induced complications (expulsion, uterine perforation, pelvic inflammatory disease), LNG-IUS continuation rate and hospital costs after one year, as well as, the budgetary impact of the use of LNG-IUS in the treatment of HMB vs. hysterectomy. RESULTS: Two hundred and sixty-seven medical files were initially retrieved for analysis. A total of 246 patients were included in this study, 122 received the LNG-IUS and 124 were treated with hysterectomy. The mean age was 39.7 years in the LNG-IUS group and 47.9 in the surgery group. Mean duration of HMB in the hysterectomy group was 3.2 years, twice that of the LNG-IUS group (1.5 years) (p<0.01). Of the patients treated with LNG-IUS, 88.7% maintained the device for over one year and 83.1% had success in bleeding control with this method. Fourteen patients had to have the LNG-IUS removed prior to 12 months; however, only 1.6% because of failure in bleeding control. Costs for the LNG-IUS insertion in a one-year time horizon were R$ 762.64 versus R$ 870.03 for the hysterectomy procedure. CONCLUSIONS: When applied to the eligible population in SUS the budgetary impact of the LNG-IUS adoption was an economy of almost R$ 3.6 million.