Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disease, which is mainly characterized by hyperandrogenemia, rare or anovulation, and polycystic ovarian changes. PCOS is seriously harmful and its causes are complex, which has not yet been clarified. Studies have shown that non-coding RNAs play important roles in the development of PCOS, including the regulation of hormone metabolism and follicle development. Exosomes are natural nano-scale membrane vesicles that contain cell-specific proteins, lipids, nucleic acids, and other biologically active molecules. Exosomes are important mediators for intercellular communication and new targets for disease diagnosis and treatment. Recent studies have shown that as an important component of follicle microenvironment, exosome is closely related to the pathogenesis of PCOS. Exosome and exosomal non-coding RNAs are expected to serve as potential new diagnostic and therapeutic targets for PCOS. In this review, we will summarize the function of exosome and exosomal non-coding RNA in the pathogenesis, diagnosis, and treatment of PCOS.