Female reproductive tract lesions are diverse, ranging from benign inflammation to malignant tumors, all of which seriously threaten women’s health. Early accurate diagnosis is crucial for improving prognosis. As the “gold standard” for diagnosis, histopathological examination is difficult to meet the needs of clinical screening and dynamic monitoring due to limitations such as invasiveness and sampling restrictions. Optical Coherence Tomography (OCT), as a non-invasive, real-time, and high-resolution imaging technology, can clearly display the microstructure of biological tissues, known as “optical biopsy”, and shows promising application prospects in the diagnosis of female reproductive tract lesions. This article systematically reviews the basic principles of OCT technology, the research progress on the correlation between OCT image features and histological features in lesions of different parts of the female reproductive tract such as the cervix and endometrium, analyzes the diagnostic efficacy, advantages and limitations of OCT technology, and prospects its future development direction, aiming to provide a reference for the clinical application of OCT technology in the diagnosis of female reproductive tract diseases.