Objective To analyze the effects of occupational exposure to high-frequency electromagnetic fields (HF-EMF) on female reproductive health, endocrine and neurobehavioral functions, and to provide a basis for conducting occupational health risk assessment and formulating targeted protection strategies. Methods From February 2023 to February 2025, 120 female employees from the communication, medical, and electronic manufacturing industries in a region were selected as the exposure group. Concurrently, 100 female office employees without occupational exposure to HF-EMF were selected as the control group. Their demographic characteristics and reproductive health status were collected through questionnaire surveys. Electrochemiluminescence immunoassay was used to detect endocrine hormone levels, including follicle stimulating hormone, luteinizing hormone, estradiol, progesterone, and prolactin. The World Health Organization Neurobehavioral Core Test Battery was used to measure neurobehavioral function. Results The rates of abnormal menstrual cycles, abnormal menstrual flow, spontaneous abortion, and preterm delivery in the exposure group were higher than those in the control group, with statistically significant differences (P < 0.05). Luteinizing hormone level of the exposure group in the follicular phase was lower than that of the control group, and the difference was statistically significant (P < 0.05). Estradiol level of the exposure group in the follicular phase was also lower than that of the control group, but the difference was not statistically significant (P > 0.05). The scores of tension-anxiety, depression-dejection, rage-hostility, fatigue-inertia, and confusion-bewilderment in the emotional states of the exposure group were higher than those of the control group, while the scores of vigor-activity and digit-symbol coding were lower than those of the control group, with statistically significant differences (P < 0.05). Conclusion Occupational exposure to HF-EMF has adverse effects on female reproductive health, endocrine, and neurobehavioral function. Health protection measures for occupational exposure to HF-EMF should be strengthened to ensure the reproductive and mental health of the female occupational population.