Metabolic homeostasis and female reproductive health are governed by tightly coupled regulatory systems, yet their reciprocal interactions have often been investigated in isolation. In this Review, we synthesize current epidemiological, mechanistic and clinical evidence to propose an integrated framework in which dynamic, bidirectional crosstalk between key metabolic organs and endocrine mediators constitutes a central determinant of female reproductive function across the life course. We delineate how disruption of this integrated network underpins a broad spectrum of reproductive dysfunction, particularly in polyendocrine metabolic ovarian syndrome and reproductive ageing, as well as cardiometabolic risk, highlighting the bidirectional nature of these associations. Finally, we critically evaluate current metabolism-targeted strategies, including lifestyle interventions, metabolic surgery and pharmacological therapies, and discuss emerging opportunities for precision approaches. By integrating mechanistic insights with clinical evidence, this Review reframes female reproductive disorders from a systemic metabolic perspective and outlines future directions for metabolism-focused strategies to improve reproductive health outcomes.