Ferroptosis is an emerging form of iron-dependent cell death regulated by lipid peroxidation. It has revealed novel mechanisms underlying the onset and progression of disease across various fields such as cell biology and pathology, providing fresh insights and promising therapeutic targets for the treatment of numerous intractable diseases. The intestinal microbiota constitutes the largest microecological system within the human body and plays a crucial role in maintaining host health by regulating various physiological processes, including metabolism, immunity, and neural activity. In recent years, accumulating evidence has emphasized a close relationship between intestinal microbiota and ferroptosis in various pathological conditions. This article reviews the latest research on the mechanisms of ferroptosis and its regulation by intestinal microbiota, aiming to provide a comprehensive understanding of the role of ferroptosis in diseases, and to offer both a theoretical foundation and practical guidance for the development of novel therapeutic strategies based on regulating intestinal microbiota.