Langsford began her career as a continuity announcer and newscaster with ITV regional station Television South West (TSW) in Plymouth, England. She left TSW when Westcountry Television took over the franchise on 1 January 1993, closing down the station with fellow announcer, Ian Stirling.

In 1997, Langsford began dating Eamonn Holmes, though the two kept their relationship secret for years out of respect for Holmes’ first wife, Gabrielle, from whom he was separated at the time. In 2002, Langsford gave birth to their son, Jack Alexander Holmes. They were married on 26 June 2010.

From 1999 until 2002, Langsford was a regular panellist on ITV’s daytime chat show Loose Women. In 2010, she returned to the show as a stand-in anchor until 2013. Langsford rejoined Loose Women on 8 January 2014 as a regular anchor. She anchors the show in rotation with Kaye Adams, Andrea McLean and Christine Lampard.

In 2000, Langsford became a guest presenter on This Morning, and was made a regular presenter in 2006 where she co-hosted alongside Phillip Schofield, making her the longest serving presenter of the programme. Later that year, the show introduced Eamonn Holmes to co-host with Langsford every Friday. Together they currently host This Morning on Fridays, during school holidays and when Phillip Schofield and Holly Willoughby are absent from the programme.

In 2004, Langsford narrated the television series Zoo Story. She guest presented five episodes of GMTV with Lorraine in 2010. Langsford was a contestant on Marco’s Kitchen Burnout in 2010 and competed in Born to Shine in 2011.

In September 2010, Langsford co-hosted the breakfast show on BBC London 94.9 alongside Paul Ross.

In 2011, Langsford became the brand ambassador for Playtex.

In 2013, Ruth Langsford became brand ambassador for Clarivu™ refractive lens exchange procedure sold by Optegra. In 2014, the Advertising Standards Authority (ASA) banned a TV commercial featuring Langsford on the grounds that her claims about Clarivu™ were misleading.

In 2014, Langsford and Eamonn Holmes co-hosted ten episodes of the ITV teatime quiz show Gift Wrapped.

Since 2015, Langsford and Holmes have presented Channel 5 series How the Other Half Lives, and a third in 2017.

Langsford was on the judging panel for the Pride of Britain Awards in 2016.

In February 2017, Langsford began co-presenting Ruth Langsford’s Fashion Edit alongside Jackie Kabler for QVC.

On 9 August 2017, Langsford was the third celebrity announced to be taking part in the fifteenth series of Strictly Come Dancing. Her professional partner was Anton du Beke. She was the seventh celebrity to be eliminated, and left the show on 12 November.

From March 2018, Langsford co-presented Do the Right Thing with Eamonn Holmes on Channel 5.