Premature ovarian insufficiency (POI) is a clinical syndrome of premature ovarian failure in women of childbearing age, which is characterized by menstrual disorder, fertility decline and perimenopause symptoms before 40 years of age. Recent studies have shown that extracellular vesicles (EVs), as a natural carrier of bioactive molecules, can effectively transport nucleic acids, proteins and other functional substances, and show significant therapeutic potential in improving ovarian tissue damage, promoting granular cell proliferation and inhibiting apoptosis. Although EVs has broad clinical application prospects in the field of regenerative medicine, it still faces technical bottlenecks in the aspects of 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 break through existing technical barriers. In this paper, the biological characteristics of EVs and its mechanism of action in the treatment of POI were systematically reviewed, with emphasis on the key technological breakthroughs of engineering modification strategies in improving the therapeutic efficacy of EVs, and the prospects of its future translational application in the field of reproductive medicine were prospected.