She was born in Cetinje as daughter of Montenegrin Prince and future King Nicholas I and his wife Milena. At the age of 10, she went to the Institute for young ladies in Saint Petersburg, Russia. She was very talented at painting and architecture and she designed the monument for Prince-Bishop Danilo I.
As the result of Elena's marriage to King Victor Emmanuel III of Italy on 24 October 1896, she converted to Catholicism from Orthodoxy and became Queen of Italy when her husband acceded to the throne in 1900. Her mother was so distressed with the fact that Elena had changed her religion that she refused to come to the wedding ceremony in Rome.
Due to the Fascist conquest of Ethiopia in 1936 and Albania in 1939, Queen Elena briefly used the claimed titles of Empress of Ethiopia and Queen of Albania; both titles were dropped when her husband formally renounced them in 1943.
She influenced her husband to lobby Benito Mussolini, Prime Minister of Italy, for the creation of the independent Kingdom of Montenegro in 1941. In 1943 she subsequently obtained the release from a German prison of her nephew, Prince Michael of Montenegro, and his wife, Geneviève. Prince Michael had been imprisoned after refusing to become King of Montenegro under the protection of Italy.
On 29 July 1900, following his father's assassination, Victor Emmanuel ascended the Italian throne. Officially, Elena assumed her husband's whole titles: she became Queen of Italy, and with the birth of the Italian Colonial Empire she became Queen of Albania and Empress of Ethiopia.
On 28 December 1908 Messina was hit by a disastrous earthquake. Queen Elena helped with the rescuers, as some photographs show. This helped to increase her popularity within the country. During the First World War Elena worked as a nurse and, with the help of the Queen Mother, she turned Quirinal Palace and Villa Margherita into hospitals. To raise funds, she invented the "signed photograph", which was sold at the charity desks. At the end of the war, she proposed to sell the crown treasures in order to pay the war debts.
Elena was the first Inspector of the Voluntary Nurses for the Italian Red Cross from 1911 until 1921. She studied medicine and was able to obtain a laurea honoris causa. She financed charitable institutions for people with encephalitis, tuberculosis, former soldiers and poor mothers.
She was deeply involved in her fight against disease, and she promoted many efforts for the training of doctors, and for research against poliomyelitis, Parkinson's disease and cancer.
On 15 April 1937 Pope Pius XII gave her the Golden Rose of Christianity, the most important honour for a Catholic lady at the time. Pope Pius XII, in a condolence telegram sent to her son Umberto II for the queen's death, defined her a "Lady of charitable work".
In 1939, three months after the German invasion of Poland and the declaration of war by the United Kingdom and France, Elena wrote a letter to the six European queens still neutral (Queen Alexandrine of Denmark, Queen Wilhelmina of the Netherlands, Grand Duchess Charlotte of Luxembourg, Queen Elisabeth of Belgium, Queen Ioanna of Bulgaria and Queen Maria The Queen Mother of Yugoslavia) in order to avoid the great tragedy World War II would become.
On 25 July 1943 Victor Emmanuel III had Benito Mussolini arrested. The king left Rome on 9 September to flee to Brindisi with the help of the Allies and Elena followed her husband in his escape. In contrast, on 23 September their daughter Mafalda was arrested by the Nazis and sent to Buchenwald concentration camp, where she died in 1944.
Following the war, on 9 May 1946 Victor Emmanuel III abdicated in favour of his son Umberto. The former king assumed the title of Count of Pollenzo, and went into exile to Egypt with Elena.
King Victor Emmanuel III of Italy and Queen Elena had 5 children:
8 January 1873 – 24 October 1896: Her Highness Princess Elena of Montenegro
24 October 1896 – 29 July 1900: Her Royal Highness The Princess of Naples
29 July 1900 – 9 May 1946: Her Majesty The Queen of Italy
9 May 1936 – 5 May 1941: Her Imperial Majesty The Empress of Ethiopia
16 April 1939 – 8 September 1943: Her Majesty The Queen of the Albanians
9 May 1946 – 28 November 1952 Her Majesty Queen Elena, Countess di Pollenzo
House of Petrović-Njegoš: Knight Grand Cross of the Order of Prince Danilo I, Special Class
House of Savoy: Knight Grand Cordon of the Royal Order of Saints Maurice and Lazarus Vatican
Holy See: Knight Grand Cross of the Order of the Golden Spur
Holy See: Knight of the Decoration of Honour
Sovereign Military Order of Malta: Knight Grand Cross of Justice of the Sovereign Military Order of Malta, 1st Class
Austrian Imperial and Royal Family: Dame of the Imperial and Royal Order of the Starry Cross, 1st Class
Bavarian Royal Family: Dame Grand Cross of the Royal Order of Theresa
Bulgarian Royal Family: Dame Grand Cross of the Royal Order of Merit
Iran: Dame Grand Cordon of the Order of Aftab
Spanish Royal Family: 945th Dame Grand Cross of the Royal Order of Queen Maria Luisa
Yugoslavian Royal Family: Dame Grand Cross of the Royal Order of St. Sava
Holy See: Recipient of the Golden Rose (twice)
- Princess Yolanda Margherita Milena Elisabetta Romana Maria of Savoy (1901–1986), married to Giorgio Carlo Calvi, Count of Bergolo, (1887–1977);
- Princess Mafalda Maria Elisabetta Anna Romana of Savoy (1902–1944), married to Prince Philipp of Hesse (1896–1980) with issue;
- Prince Umberto Nicola Tommaso Giovanni Maria of Savoy, Prince of Piedmont, later Umberto II, King of Italy (1904–1983) married Princess Marie José of Belgium, with issue.
- Princess Giovanna Elisabetta Antonia Romana Maria of Savoy (1907–2000), married to Boris III, King of Bulgaria;
- Princess Maria Francesca Anna Romana of Savoy (1914–2001), who married Prince Luigi of Bourbon-Parma (1899–1967), with issue.