Premature ovarian insufficiency ( POI) is a clinical syndrome of premature ovarian failure in women of childbearing age, characterized by menstrual disorder, fertility decline, and perimenopausal symptoms before 40 years of age. Recent studies showed that extracellular vesicles (EVs), as a natural carrier of bioactive molecules, could effectively transport nucleic acids, proteins, and other functional substances, and showed significant therapeutic potential for improving ovarian tissue damage, promoting granular cell proliferation, and inhibiting apoptosis. Although EVs have broad clinical application prospects in the field of regenerative medicine, they still face technical bottlenecks in terms of their targeted delivery efficiency, biological stability, and large-scale preparation.Innovative modification strategies based on bioengineering technologies, including membrane surface functionalization,precise content loading, and microenvironment pretreatment, provide effective solutions to overcome existing technical barriers. This review considers the biological characteristics of EVs and their mechanism of action in the treatment of POI, with an emphasis on the key technological breakthroughs of engineering modification strategies for improving the therapeutic efficacy of EVs, and the prospects for their future translational application in the field of reproductive medicine.