Uterine fibroids (UF) affect more than one-fifth of US reproductive age women. While multiple medical therapies are available, there are little data on how long patients stay on a medical therapy before they switch to other medications or procedural treatment. Identifying successful and lasting medical therapies would better inform patients and providers, and reduce the number of hysterectomies. This study compares four medication classes (short-acting reversible contraceptive steroids (SARC), long-acting reversible contraceptive steroids (LARC), leuprolide acetate (LA) and tranexamic acid (TA) for controlling heavy menstrual bleeding (HMB) in UF patients. Using a large private health insurance claims database (Optum Labs Data Warehouse), we identified women aged 18-54 with UF and HMB diagnoses and medical therapy between 2000 and 2013. We defined patients’ first medication after diagnosis as the index medication (and the study drug cohorts), and assessed the duration of their index medical therapy and whether they switched. Propensity score matching and survival analysis were used to compare different medications. Of the 41,561 eligible women, the four drug cohorts had 33,000 (79.4%: SARC), 3,928 (9.5%: LARC), 3,525 (8.5%: LA), and 1,108 (2.7%: TA), respectively. 16,594 (40.0%) switched to non-index medication or procedural treatment. Among the patients who switched, 45.7% switched to hysterectomy, 24.1% switched to endometrial ablation, 8.5% switched to myomectomy, and 18.4% switched to another medication class. Patients on LARC were much less likely to switch in the short term (e.g., within 60 days), but the effect was similar to SARC in the long term (on average HR=0.63, p<0.001). Patients on leuprolide acetate (HR=2.41, p<0.001) and tranexamic acid (HR=1.49, p<0.001) were more likely to switch, compared to those on SARC. When treating HMB related to UF, women are more likely to stay on medications that have contraceptive benefits (i.e., LARC and SARC), compared to leuprolide acetate and tranexamic acid.