The ER-α gene polymorphisms have been reported to be associated with uterine leiomyoma (ULM) risk. The purpose of the present study was to perform a meta-analysis to explore the polymorphisms in the ER-α gene and the risk of ULM. A comprehensive search for relevant articles was conducted in MEDLINE (Ovid), PubMed, Embase, Springer, EBSCO, Web of Science, CNKI, Wanfang, Weipu, and Google Scholar. A total of nine articles were identified. Among the nine articles, 11 cohorts reported the PvuII polymorphism and six reported the XbaI polymorphism. The strength of the relationships between the polymorphisms in ER-α (PvuII and XbaI) and the risk of ULM was assessed by odds ratios (ORs). The studies provided overall OR estimates for PvuII and XbaI, leading to a pooled OR of 1.41 (PP+Pp vs. pp: OR = 1.41, 95 % confidence interval (95 %CI) = 1.02-1.96, P = 0.04), 1.13 (XX+Xx vs. xx: OR = 1.13, 95 %CI = 0.91-1.41, P = 0.25), respectively. The PvuII polymorphism in the ER-α gene may be a risk factor for ULM. Future studies are needed to validate our conclusions.