Reactive oxygen species (ROS) are reactive products of cellular metabolism that, under physiological conditions, activate specific signaling pathways essential for cellular functions. Excessive accumulation of ROS overwhelms cellular antioxidant defenses, leading to functional damage or cell death. ROS-mediated cell death manifests in multiple forms, including apoptosis, ferroptosis, immunogenic cell death, pyroptosis, oxeiptosis, NETosis, and parthanatos. In gynecological malignancies, inducing ROS-mediated cell death is proposed as a therapeutic strategy. Furthermore, research indicates that excessive ROS promotes abnormal phase separation, resulting in functional damage to tumor cells. Therefore, ROS-mediated cell death and phase separation provide a new entry point for preventing tumorigenesis or treating gynecological malignancies. In this review, we summarize the mechanisms underlying ROS-mediated cell death and phase separation, and describe innovative strategies based on ROS that hold promise for treating gynecological malignancies. This review will also discuss controversial issues in tumor therapeutics, including the paradoxical roles of ROS manipulation. This will offer new insights into the management of gynecological malignancies, providing theoretical support for clinical practice.