Uterine leiomyomas are monoclonal, benign tumors arising from the uterine myometrium. Fibroids are the most common tumor affecting 70% of white women and 80% of African American women near the age of menopause. Uterine leiomyomas may be asymptomatic or cause symptoms including heavy menstrual bleeding, anemia, pressure symptoms, or reproductive dysfunctions. Compared to their white counterparts, black women are two to three times more likely to have uterine fibroids, have fibroid starting at younger age, with often larger and multiple tumors, and often suffering from severer symptoms. In addition, black women undergo hysterectomy at a younger age than white women, with less utilization of minimally invasive techniques. In this chapter, we examine clinical evidence of racial disparity in incidence, clinical presentation, and the healthcare provided to women with uterine leiomyoma. In addition, we review potential molecular mechanisms that can explain it.