BACKGROUND: Premature ovarian insufficiency (POI) is a condition in women characterized by the premature decline of ovarian function before age 40, evident through menstrual irregularities such as amenorrhea or oligomenorrhea, elevated FSH levels exceeding 25 U/L, and a progressive decrease in estrogen levels. Despite considerable research, the exact pathogenic mechanisms underlying POI remain unclear. This study focuses on the role of microRNAs (miRNAs) in the development of POI. As critical regulators of gene expression, miRNAs may play significant roles in diagnosis and the development of innovative therapeutic approaches for POI. METHODS: A comprehensive literature search was conducted on PubMed for this review. We included studies published in English up to September 2024. Our search utilized a combination of the following keywords: microRNA, premature ovarian insufficiency (POI), and premature ovarian failure (POF). Articles were filtered by title and subsequently through full-text review, selecting only those pertinent to our topics of interest and their related areas. RESULTS: miRNAs have emerged as critical regulators in POI, mediating a range of biological processes that contribute to the disease's progression. Their involvement offers promising insights for early diagnosis, prognostic assessments, and therapeutic interventions, highlighting their potential as biomarkers and therapeutic targets. CONCLUSION: Elucidating miRNAs' roles in POI opens new avenues for managing the disease. By understanding how miRNAs influence the molecular mechanisms of POI, innovative strategies can be developed for diagnosis and treatment, potentially improving patient outcomes.