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Momordica charantia L. is a kind of vegetable with medicinal value. As the main component of the vegetable, Momordica charantia polysaccharides (MCPs) mainly consist of galactose, galacturonic acid, xylose, rhamnose, mannose and the molecular weight range is 4.33 × 103–1.16 × 106 Da. MCPs have been found to have various biological activities in recent years, such as anti-oxidation, anti-diabetes, anti-brain injury, anti-obesity, immunomodulatory and anti-inflammation. In this review, we systematically summarized the extraction methods, structural characteristics and physicochemical properties of MCPs. Especially MCPs modulate gut microbiota and cause the alterations of metabolic products, which can regulate different signaling pathways and target gene expressions to exert various functions. Meanwhile, the potential structure-activity relationships of MCPs were analyzed to provide a scientific basis for better development or modification of MCPs. Future researches on MCPs should focus on industrial extraction and molecular mechanisms. In East Asia, Momordica charantia L. is used as both food and medicine. It is not clear whether MCP has its unique biological effects. Further study on the difference between MCPs and other food-derived polysaccharides will be helpful to the development and potential application of Momordica charantia L. [ABSTRACT FROM AUTHOR]