Sustained and controlled release drug delivery systems (DDSs) are widely investigated for disease diagnosis and treatment. Advanced DDS provides critical advantages over traditional DDSs, particularly by bypassing systemic circulation and first-pass metabolism. This enhances the drug payload at the target site and reduces systemic side effects. Uterine drug delivery is already widely used with contraceptive intrauterine devices, but further explorations to treat uterine fibroids, uterine cancer, and endometriosis are still being developed. Advances in these systems will provide critical clinical enhancements over the current treatment options.