As life expectancy continues to extend, the adverse effects of reproductive aging on female health have become progressively conspicuous. Despite the extant focus on symptom alleviation, a paucity of pharmaceutical interventions addresses the underlying causative factors. Exosome therapy, acknowledged for its relatively safe cell-free approach, emerges as a promising avenue. Notably, exosomes derived from stem cells exhibit comparable efficacy to their cellular counterparts. Nevertheless, extant methodologies for exosome production exhibit several limitations, particularly in achieving high-caliber, large-scale manufacturing. Consequently, this review is dedicated to elucidating the ongoing research endeavors and advancements of exosome therapy pertaining to the female reproductive aging.