Metaprogramming involves writing code that manipulates language constructs and generates or modifies code at runtime. This allows developers to define domain-specific languages, remove duplications, and enhance Ruby's core functionality. Everything in Ruby is an object, including classes and modules. Metaprogramming techniques like monkey patching, dynamic methods, and refinements allow modifying classes and modules at runtime. However, metaprogramming should be avoided when possible, as it can reduce code readability and maintainability.