In the mid-1980s, Itō's writing gravitated to issues of the feminine body, sexuality, and motherhood, making her the most prominent voice of what came to be known as the "women's poetry boom."

[3] Her eagerness to explore women's issues has led some to think of her as a feminist writer, although this is a term that Itō has not always embraced in building her public persona.

A few years later in 1993, Itō explicitly played out the metaphor of poet as shamaness in her long narrative poem 'I Am Anjuhimeko' (わたしはあんじゅひめ子である, Watashi wa Anjuhimeko de aru), in which she takes a story recorded from a shamaness in Tsugaru in the early 20th century and refashions it into a dramatic new myth of healing from sexual abuse and self-discovery.

She had recently separated from her husband, the literature scholar Masahiko Nishi, and at Rothenberg's invitation, she started making regular, extended trips to America with her children, before eventually settling in 1997 in Encinitas, California with her new partner, the British artist Harold Cohen.

In these works, Itō writes about the experiences of modern people, often migrants or transnationals, but does so in a way that has an almost mythological grandeur and frequently veers into the surreal.

One of Itō's bestsellers was her book of essays The Heart Sutra Explained (読み解き般若心経, Yomitoki Hannnya shingyō), published in 2010.

A common theme in these books, especially The Heart Sutra Explained, Reading the Lamentations of Divergences Falteringly Out Loud, and the 2014 book A Father's Life (父の生きる, Chichi no ikiru) about the slow decline and death of Itō's father, is the question of how life changes as one grows older and faces death.

In addition to these works of poetry and prose, Itō has published numerous books of essays, manga criticism, and translations of American literature for young Japanese readers.