Lymphangioleiomyomatosis (LAM) is a rare cystic lung disease occurring almost exclusively in women of childbearing age. Genetic analysis has revealed common mutations in both the TSC1 and TSC2 genes that lead to both sporadic cases of LAM (S-LAM) and those associated with the tuberous sclerosis complex (TSC-LAM). S-LAM is characterized by multiple pulmonary and nonpulmonary complications including progressive airflow obstruction, recurrent pneumothoraces, chylothoraces, and renal angiomyolipomas. Despite the putative role of estrogen in the pathogenesis of this disease, antiestrogen therapies have not shown benefit in prospective clinical trials. Recent insights into the molecular pathogenesis of LAM have offered hope for newer therapies targeting specific signaling pathways that are believed to drive LAM cell proliferation. Patients should be encouraged to participate in clinical trials that will help determine the efficacy of these novel therapies. However, until these therapies are proven to be beneficial, lung transplantation remains the only viable option for patients with progressive end-stage lung disease.