OBJECTIVES: Uterine fibroids (UF) are a common cause of morbidity in premenopausal women. Limited data exist on the comparative effectiveness of currently available treatments however, due in part to feasibility issues with randomized clinical trials and prospective observational studies in this area.  We therefore conducted a retrospective cohort study to compare the durability of uterus­conserving treatments for symptomatic fibroids in terms of subsequent procedures following the initial surgical intervention. METHODS: We used a linked electronic medical record (EMR)­claims database with over 2.2 million patients in the United States to assemble a cohort of females aged 18­54 years with a UF diagnosis and treated with at least one procedure of interest (myomectomy [MYO], endometrial ablation [EA], uterine artery embolization [UAE]) occurring between 01/01/05–12/31/11. Time to subsequent procedure after the initial surgery was compared using a proportional hazards regression model, adjusting for age, race, region, and number of comorbidities and baseline symptoms. RESULTS: Among 2648 women with UF, the mean age was 43 (SD=6.2) years; 43% were Caucasian, 25% African-American; and 55% were from the South region. EA was the most common index procedure (48%), followed by MYO (41%) and UAE (11%).  The adjusted hazard rates for MYO and for UAE (vs. EA) were 0.67 (95% CIs: 0.54-0.84) and 0.55 (95% CIs: 0.39-0.79), respectively.     CONCLUSIONS: We found that women who had UAE were less likely to have a subsequent procedure during the study period than women who had EA, with women who had MYO falling in between.  We recognize that these findings might be explained, in part, by other disease-related factors that were not available in the EMR-claims data, e.g. the size and number of fibroids.  The results from this study and future UF comparative effectiveness studies will help patients and health care providers make informed decisions in this therapeutic area.