This review examines the role glycerophospholipids (PL) in dairy cow health, with specific focus on phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylinositol (PI) and phosphatidylserine (PS). Increasing parity of cows is associated with lower concentrations of plasma PL that contain very long-chain omega-3 fatty acids, including docosahexaenoic acid and eicosapentaenoic acid, which are precursors for prostaglandin synthesis, and have anti-inflammatory roles. Low concentrations of these PL could plausibly contribute to the increased risk of disease, reproductive failure and mortality in older cows. The bioavailability and metabolism of fatty acids may differ among supplements that are predominately neutral lipids, such as triacylglycerol-rich oils, and those bound to PL including pasture, whole or ground oilseeds and fish meal. Hepatic lipidosis can occur during the transition period if there is insufficient very-low density lipoproteins (VLDL) production in the liver to transport lipids into blood circulation. The PC are the primary PL of VLDL and are produced by two main pathways in the liver, the cytidine diphosphate-choline pathway that uses choline as a substrate, and the PE N-methyltransferase pathway that uses PE and methyl-donors as substrates. Co-supplementation strategies that target both pathways may increase PC production over a one-pathway supplementation strategy. The PIs are phosphoinositides precursors, which have broad physiological roles including regulating inflammatory processes and may offer targets for novel treatment and management of disease. Both the PI and PE are precursors to endocannabinoids, important regulators of energy metabolism, immune function and reproduction in mammals. Early findings on the endocannabinoid system in transition dairy cows yielded results that diverge from non-ruminant models. The PS expression on cytoplasmic membranes signals apoptosis, coagulation and contributes to sperm–oocyte recognition. As lipidomic diagnostics become increasingly available, understanding the metabolism of PL will continue to develop and promises to offer novel strategies for optimising cattle health and longevity.