This systematic review and meta-analysis evaluated the effectiveness of acupuncture for anxiety and depression in women with polycystic ovary syndrome (PCOS). It included 12 randomized controlled trials with 2127 patients (1059 in the acupuncture group, 1068 in the control group). Acupuncture significantly reduced anxiety scores (MD = -6.42, 95% CI -8.91 to -3.56; p < 0.00001) and depression scores (MD = -5.89, 95% CI -9.01 to -2.78; p = 0.0002) compared to controls. It also improved testosterone levels (MD = -0.05, 95% CI -0.11 to 0.00; p = 0.05), BMI (MD = -0.70, 95% CI -1.19 to -0.21; p = 0.005) and waist-to-hip ratio (MD = -0.06, 95% CI -0.11 to -0.01; p = 0.03), with no significant adverse effects (OR = 0.08, 95% CI 0.01 to 0.81; p = 0.03). It had no significant effect on insulin resistance (MD = -0.41, 95% CI -1.18 to 0.37; p = 0.31). The most frequently used meridians were SP, CV and ST, with a combination of points SP6, LR3 and ST36. The conclusion describes acupuncture as safe and effective, but highlights limitations such as small sample size and heterogeneity.