One of the deadliest forms of cancer, ovarian cancer (OC), affects women's gonads [1]. The OC is the eighth most common cancer in women globally, both in terms of its incidence and mortality, according to estimates from GLOBOCAN. In 2020, an estimated 314,000 women were diagnosed with OC, and 207,00 women died as a result of the illness [2]. Regarding gynecological cancers, OC is the third most prevalent overall. While endometrial and cervical cancers are more common, OC has the highest fatality rate of all gynecological malignancies [3].

Compared with other types of stromal and germline tumors, epithelial OC is by far the most prevalent form of the disease [4]. Early OC has minimal clinical signs. Hence most instances (>70%) are detected late. When the tumor spreads to the peritoneal cavity and upper abdominal organs, it becomes very aggressive, difficult to treat, and has a high recurrence rate and low 5-year survival rate. An in-depth study into the epigenetics of OC will assist in early identification, diagnosis, and therapy [5].

Regarding OC treatment, its 1ry goal is to maximize tumor management and symptom palliation as long as possible. So, the main approach is surgical procedures, whose extent is determined by patient factors and cancer stage [6]. Besides surgery, platinum-based chemotherapy may be used as adjuvant therapy, either alone or in combination with paclitaxel, according to the disease stage [7].

At the molecular disease etiology level, OC is characterized by a high degree of heterogeneity [8]. Genetic and epigenetic modifications contribute to the development of OC, which may be caused by gene amplification, deletion, and methylation state changes [9]. Therefore, there is an immediate need to discover suitable biomarkers that may be used to diagnose OC early.

Single-stranded, noncoding RNAs called microRNAs (miRNAs, miR) that consist of around 20–24 nucleotides are important in controlling genetic material and cell signaling [10]. Recently, many additional disorders, such as metabolic syndrome, infections, and diabetes, have been linked to the biological relevance of miRNA, which was initially identified in cancer [11], [12], [13], [14].

Ovarian cancer is one of the many forms of human cancer for which miRNAs have been identified as potential indicators. The availability of detection and quantification techniques of miRNAs in blood samples is the most significant indicator of these transcripts' suitability for early cancer diagnosis [15].

A large-scale genome study revealed that miRNAs are abnormally expressed in several disease types [16]. In addition, particular miRNAs are related to chemotherapy resistance and clinical outcomes, suggesting their involvement in ovarian tumorigenesis or cancer development [17].

Standard therapy for OC is a combination of platinum and taxane drugs, although many patients develop resistance and recurrence. Epidemiological studies have shown that anovulation, oral contraceptive usage, and tubal ligation minimize the incidence of OC [18]. Numerous studies have shown that activation of several pathways is essential for chemoresistance and target-specific suppression of OC stem cells [19], [20]. Molecular pathways were revealed to be highly active in OC precursor lesions [21].

In the present review, we provide an overview of the initiation and progression of OC, in addition to the link between OC and miRNA, as well as new findings regarding the role of microRNAs in the pathogenesis of OC, their use as biomarkers, and the future implications of this research field.