Results from this meta-analysis highlight two distinct genetic pathways that play a role in the development of leiomyomas; one of genes linked to tumorigenesis (TP53, TERT, ATM, and OBFC1) and the other of variants and loci linked to hormone metabolism (CDC42/WNT4, GREB1, MCM8, and SYN1/ESR1). This evidence concerns the gene ESR1 and leiomyoma.