Objectives: To evaluate the relation between serum adipocytokines' levels and the development of uterine leiomyoma (UL) in symptomatic (Group II) or asymptomatic (Group III) women. Patients & Methods: 60 women presenting by pelvic pressure manifestations, secondary infertility, or recurrent pregnancy loss (RPL) with (Group II) or without (Group III) abnormal uterine bleeding (AUB) were enrolled in the study. Thirty women who UL-free and were of cross-matched age and BMI to were collected as control group (Group I). All women underwent complete clinical and ultrasonographic evaluation and gave blood samples for ELISA estimation of serum tumor necrosis factor-α (TNF-α), adiponectin and leptin Results: Serum levels of TNF-α and leptin were significantly higher in samples of women of group II in comparison to levels estimated in blood samples of women of group I and III with significantly higher levels in blood samples of women of group III than in group I. Serum levels of adiponectin estimated in blood samples obtained from patients of groups II and III were significantly lower than in samples of group I with non-significant differences between levels estimated in samples of groups II and III. Statistical analyses defined high serum TNF-α and leptin as significant positive predictors, while high serum adiponectin was a significant negative predictor for UL presence. The Automatic Linear Modeling analysis defined high serum levels of TNF-α as the most important predictor for presence of UL and its manifestations. Conclusion: The prevalence of UL is high and may not be present by AUB but disturbed fertility. Development of UL might be considered as a consequent event to disturbed adipocytokines levels. Estimation of serum TNF-α in woman suspected to have UL is indicated for its diagnostic probability and relation to the multiplicity of symptoms. Keywords: Uterine