Microwave-assisted enzymatic ring-opening polymerization (eROP) has emerged as a promising green approach for the synthesis of biomedical polymers with potential applications in drug delivery systems and implantable biomaterials. This review provides a critical overview of the current state of microwave-assisted eROP, with particular emphasis on systems catalyzed by Candida antarctica lipase B (CALB), the most widely used biocatalyst in this field. The fundamental aspects of CALB-catalyzed polymerization, including its catalytic mechanism and key parameters influencing reaction efficiency, are discussed under both conventional and microwave-assisted conditions. Microwave irradiation can offer significant advantages, such as reduced reaction times, improved energy efficiency, and, in some cases, enhanced polymer properties, including higher molecular weight and narrower dispersity. However, its effects are strongly dependent on reaction conditions, including solvent properties, temperature, and enzyme stability, with both accelerating and inhibiting effects reported. The review summarizes the current literature on microwave-assisted eROP of representative cyclic monomers, including ε-caprolactone, ω-pentadecalactone, and L-lactide, highlighting the influence of microwave parameters on polymerization outcomes and material properties. Despite promising results, microwave-assisted eROP remains relatively underexplored, with limited monomer scope and incomplete understanding of microwave–enzyme interactions. Challenges such as enzyme deactivation, lack of standardized methodologies, and scalability issues are also addressed. Overall, microwave-assisted eROP of cyclic monomers represents a sustainable and efficient strategy for producing high-quality pharmaceutical polymers. However, further research is required to fully realize its potential in industrial and biomedical applications.