Premature ovarian insufficiency (POI) is a condition that severely impacts female physical and mental health; it is a primary cause of female infertility, with its incidence rate continuously rising in recent years. Although hormone replacement therapy has achieved good efficacy in clinical practice, its long-term use can lead to many adverse reactions. Finding safe and effective POI treatments has become an urgent issue. Traditional Chinese medicine can regulate phosphatidylinositol 3-kinase / protein kinase B (PI3K/ Akt), Wnt family secreted glycoprotein /β-catenin (Wnt / β-catenin), transforming growth factor-β (TGF-β) / Smads, and nuclear factor erythroid 2-related factor ( Nrf2) signaling, along with other related signaling pathways. It can also inhibit follicular granulosa cell apoptosis, reduce inflammatory responses and oxidative stress damage, regulate hormone levels, improve ovarian function, and delay ovarian aging. Traditional Chinese medicine presents advantages in POI treatment, with significant clinical effects and high safety. Through exploring research into the signaling pathways in POI, this paper reviews and analyzes literature on the active components of traditional Chinese medicine and their use in POI treatment by modulating related signaling pathways, aiming to offer guidance for future research.