Uterine fibroids (also referred to as leiomyomas or myomas) represent the most common pelvic neoplasms in women. Incidence is difficult to determine since there are only a few longitudinal studies. They are noncancerous monoclonal tumors arising from the smooth muscle cells and fibroblasts of the myometrium. The pathogenesis of leiomyomas is not well-understood. Genetic predisposition, environmental factors, steroid hormones, and growth factors all play a role in the formation and growth of uterine fibroids. Uterine fibroids arise in reproductive-age females, and, when symptomatic, typically present with symptoms of abnormal uterine bleeding (AUB) and/or pelvic pain/pressure. Uterine fibroids may also have reproductive effects (e.g., infertility, adverse pregnancy outcomes). The clinical diagnosis of uterine leiomyomas is made based on a pelvic examination and pelvic ultrasound findings consistent with a uterine leiomyoma. Characteristic symptoms further support the clinical diagnosis, although many patients are asymptomatic. The patient’s desire for immediate or future pregnancy must be assessed prior to choosing any treatment as the therapies have differing impacts on fertility. For patients who do not desire fertility, treatment is aimed at symptom reduction. First-tier treatment in these patients includes hysteroscopic fibroid resection, if the fibroids are in an appropriate anatomic location, or medical treatment for those with fibroids in locations not amenable to hysteroscopic resection. Combined estrogen–progestin contraceptives (oral contraceptive pills, vaginal rings, or transdermal patches) are the most common medical therapy utilized in patients with all other types of fibroids who do not desire pregnancy. For patients who cannot use or do not want estrogen-containing contraceptives, progestin-releasing intrauterine devices (IUDs) are the main progestin-only contraceptive for fibroid-related heavy menstrual bleeding (HMB). For patients who do not desire future fertility and have persistent fibroid-related symptoms or who desire surgical treatment, the main options include hysterectomy and myomectomy. For patients who desire pregnancy and present with bulk symptoms, myomectomy via either laparoscopy (with or without robotic assistance) or an open abdominal incision is the recommended treatment.