OBJECTIVES: This study had two objectives: 1) Describe surgical treatment patterns among women with newly diagnosed uterine fibroids (UF), and 2) Estimate the medical costs associated with these surgical interventions. METHODS: The Truven Health Analytics MarketScan Commercial and Medicare Supplemental Databases were used to identify women aged ≥30 years with continuous enrollment for at least 12 months before and after the new diagnosis of UF (ICD-9-CM code 218.x) during 2010-2014. Patients with prior UF surgeries or evidence of large uterus or gynecological cancer during the study period were excluded. Receipt of hysterectomy, hysteroscopic myomectomy or uterine artery embolization (UAE) were primary outcomes. Healthcare resource utilization and costs were estimated for gynecologic-related costs (GYN) among women with at least 12 months of continuous enrollment following one of these surgical procedures. RESULTS: A total of 292,318 women with newly diagnosed UF met the selection criteria. Overall, 33.1% of patients underwent a surgical procedure for fibroids within 1 year of diagnosis. 21.9% of women underwent hysterectomy within 1 year of diagnosis, decreasing from 24.0% in 2010 to 19.3% in 2014 (p<0.001). Yearly rates of hysteroscopic myomectomy were relatively stable (range 4.8% to 5.4%). 86,767 patients met the selection criteria for the cost analysis, consisting of 72,448 hysterectomy, 10,544 hysteroscopic myomectomy, and 3,775 UAE patients. In the first month post-surgery, GYN-related costs for hysteroscopic myomectomy patients ($6,113) were approximately one-half those of hysterectomy ($13,370) or UAE ($11,237). Total annual GYN-related costs were highest for hysterectomy ($14,662) followed by UAE ($13,540), and hysterscopic myomectomy ($9,492). CONCLUSIONS: Hysterectomy was the most common UF surgical intervention and represented the greatest healthcare costs following surgery compared to minimally invasive approaches like hysteroscopic myomectomy. These results can help inform future quality and cost-effective decisions about UF surgical treatment choices.