MicroRNAs (miRNAs) are small noncoding RNAs that regulate gene expression by binding to target mRNAs, leading to their degradation or translational repression. Their dysregulation has been widely implicated in the development and progression of gynecological cancers, including ovarian, cervical, endometrial, and vulvar cancers. miRNAs influence crucial cellular processes such as cell cycle control, apoptosis, autophagy, angiogenesis, and metastasis by targeting key signaling pathways like PI3K/Akt, TGF-β, and MAPK. Recent findings also highlight the role of exosomal miRNAs in shaping the tumor microenvironment and contributing to resistance against chemotherapy and radiotherapy. This resistance is often mediated through altered expression of tumor suppressor genes and oncogenes, leading to therapeutic failure. This chapter explores the multifaceted roles of miRNAs in gynecological cancer biology, emphasizing their contribution to disease progression and therapeutic resistance, and discusses their potential as promising biomarkers and therapeutic targets.