Treating gynecological and reproductive health conditions requires a multifaceted approach, and the use of biologics is increasingly being explored. More specifically, exosomes isolated from mesenchymal stem cells derived from relevant biological sources (e.g., bone marrow, menstrual blood, etc.) have shown advantageous properties for gynecological conditions. In this chapter, we first introduce the biological role of exosomes in women’s reproductive health. Next, we summarize the current state of exosome use as a therapeutic for the following reproductive health conditions: endometriosis, polycystic ovary syndrome, infertility due to implantation failure and primary ovarian insufficiency, preeclampsia, and pelvic floor dysfunction. Exosomes in clinical trials for reproductive health applications are then highlighted. This chapter concludes with perspectives and opportunities of using exosomes as a therapeutic for disorders and complications facing women’s reproductive health. Overall, the use of exosomes to treat conditions influencing reproductive health is in an early stage, with most studies taking place within the past 5 years. With much left to be explored in the field, the advantages and challenges of exosome-based therapeutics are still being realized. The studies discussed throughout the chapter highlight the potential for transformative medicine for a range of women’s health applications.