<p>Ceramide, a central hub in sphingolipid metabolism, serves as a critical bioactive signalling mediator that integrates lipid metabolism with multiple signalling pathways, primarily promoting autophagy and apoptosis. It influences female reproductive homeostasis and pathophysiology through multiple dimensions: altered ceramide levels have been observed in various reproductive disorders—such as polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI) and endometriosis (EM)—as well as across the female lifespan. These changes impact key processes including gonadotropin release, follicular development, and uterine microenvironment homeostasis. This review systematically summarizes the effects of ceramide on female fertility, highlighting its role as a pivotal entry point for understanding reproductive endocrine disorders in women. Modulating ceramide levels may represent a promising therapeutic strategy to enhance fertility and promote female reproductive health.</p>