Small Vesicles Big Impact: Exosomes in the Landscape of Women's Health.

Extracellular vesicles (EVs), particularly exosomes, are small membrane-bound vesicles that mediate intercellular communication by transferring bioactive molecules such as proteins, lipids, and nucleic acids. Increasing evidence highlights their critical role in maintaining physiological homeostasis and in the pathogenesis of multiple diseases. In the context of women's health, exosomes have emerged as key regulators of reproductive function, endocrine signaling, immune modulation, and hormonal balance across the lifespan. This review provides an overview of exosome biogenesis, molecular composition, and functional properties, with a focus on their relevance to reproductive disorders, infectious diseases, hormonal imbalance, and menopause. We summarize recent advances demonstrating the utility of exosomes as biomarkers and diagnostic tools in conditions such as polycystic ovary syndrome (PCOS), gynecological cancers, and pregnancy-related complications. In addition, the role of placental and circulating exosomes in gestation, including their involvement in placenta-fetal communication, immune tolerance, and the pathophysiology of preeclampsia and the gestation phase, is also discussed. Furthermore, we discuss emerging evidence supporting exosome-based therapeutic roles for restoring ovarian function, modulating inflammation, and targeting tumor progression. Finally, we address current challenges in exosome isolation, characterization, and clinical translation, and outline future research directions required to harness exosome approaches to improve women's health outcomes.