Objective: This study systematically assessed temporal trends in the global burden of ischemic heart disease (IHD) attributable to high body mass index (BMI) and low physical activity (PA) among women from 1990 to 2021. Methods: Data were obtained from the 2021 Global Burden of Disease Database, which covers disability-adjusted life years (DALYs), mortality rates, years lived with disability (YLDs), years of life lost (YLLs), and age-standardized rates (ASRs) attributable to high BMI and low PA among women. ASRs and estimated annual percentage changes (EAPCs) were calculated over 32 years. Temporal trends were analyzed by country, region, and sociodemographic index (SDI). A decomposition analysis was performed, and future predictions were made using the ARIMA time-series method to assess these trends comprehensively. Results: DALYs associated with IHD attributable to high BMI in women increased from 5.17 million in 1990 to 9.87 million in 2021. Deaths increased from 243,512 to 461,122, YLDs from 85,634 to 238,639, and YLLs from 5.08 to 9.63 million. However, DALYs related to female IHD caused by low PA increased from 146 to 242 million. Deaths increased from 87,707 to 152,305, YLDs from 23,564 to 54,301, and YLLs from 144 to 236 million. Although the ASRs of DALYs, mortality, and YLLs associated with high BMI and low PA have decreased, the ASR of YLDs has remained relatively stable over 32 years. This overall increase in disease burden underscores the urgency of intervention strategies to address the risk factors of high BMI and low PA. Significant regional and national differences were observed, with the burden shifting from high-SDI areas to low- and low-middle-SDI areas, a trend further amplified by population growth and aging. Although overall health inequalities have decreased, predictions indicate that the ASR of female IHD will continue to decline over the next 29 years, whereas the ASR of YLDs is expected to increase. This indicates that although women’s health awareness is increasing, more efforts are needed to maintain cardiovascular health, reduce the burden of IHD, and improve the quality of life for women. Conclusions: Since 1990, high BMI and insufficient PA have substantially contributed to the global burden of IHD in women, with profound variation by age, region, and sociodemographic context. These effects differ from those in men due to women's unique physiological and social roles, underscoring the need for targeted health strategies aimed at women. Nations should focus on managing BMI and promoting physical activity to reduce the IHD burden and inform public health policies to improve women’s cardiovascular health and quality of life.