OBJECTIVES: To describe treatment patterns and diagnostic pathways for women with uterine fibroids up to three years following a new diagnosis.  METHODS: Patients with a new diagnosis of uterine fibroids (ICD-9 code: 218.9) were identified in the Truven Health MarketScan Research Databases from 2004-2013. The use of specific diagnostic and treatment procedures and medications were described in the 12 months prior to (pre-index) and in the 12, 24 and 36 months following (post-index) the  diagnosis (index event). Patients were required to have continuous enrollment throughout the pre- and post-index periods.   RESULTS: A total of 359,672 patients met the selection criteria with mean age 46.1 years (SD=9.3) at first diagnosis. Of those, subsets of 244,827 (68.1%) patients and 164,645 (45.8%) patients had 24 and 36 months of post-index follow-up, respectively.  Hysterectomy was the most common surgical intervention, increasing from 29.3% in the first 12 months to 35.5% in the first 36 months; average time to hysterectomy was 49.7 days. Other surgical interventions used within the first 12 months of follow-up included: endometrial ablation (5%), curettage (3.6%), and either hysteroscopic myomectomy, laparascopic myomectomy, abdominal myometcomy, or uterine emobolization (<2% each).  13.1% of women used hormonal birth control with higher rates among younger women. IUDs or Gnrh agonists were used by approximately 1% of women.  Transvaginal ultrasound was the most common imaging procedure both 12 months pre- and 36 months post-index (31.0%, 54.6%, respectively), followed by abdominal/pelvic ultrasound (27.3%, 49.6%, respectively).   CONCLUSIONS: Approximately one-third of women with newly diagnosed uterine fibroids underwent hysterectomy within the first year of initial diagnosis. Minimally invasive procedures such as hysteroscopic myomectomy were infrequently utilized, despite published evidence showing considerably lower costs and complication rates over hysterectomy.