Objective To explore the experiential process and dynamic evolution of event-related rumination among postoperative patients with gynecological malignancies, so as to provide a reference for developing targeted psychological nursing intervention stra-tegies. Methods A narrative inquiry design was adopted.Twelve patients with gynecological malignancies who were 6 months to 3 years after surgery were selected through purposive sampling for semi-structured interviews.Interview data were analyzed using Clandinin′s three-dimensional narrative inquiry framework. Results Four themes were identified:early cognitive shock and repetitive thinking, manifested as shock and repeated recall at the moment of diagnosis, repeated questioning of disease etiology, and repea-ted flashbacks of surgical experiences; gradual transformation in thinking content and patterns, including pivotal moments triggering cognitive transformation, the shift from "why" to "what to do," and setbacks and fluctuations during the transformation process; contextual factors influencing the evolution, encompassing the dual role of family support, the facilitative effect of peer support, and economic pressure and practical concerns; emergence of meaning construction, reflected in reassessment of health and life, re-examination of interpersonal relationships, and the desire to help others. Conclusion Event-related rumination in postoperative patients with gynecological malignancies exhibits a dynamic evolutionary process from intrusive to deliberate rumination, inf-luenced by multiple contextual factors. Nurses should emphasize postoperative psychological assessment and support, attend to the quality of family support, establish peer support networks, and provide targeted psychological care for patients with financial difficulties, so as to facilitate cognitive transformation and psychological adaptation.