Acupuncture improves anxiety and depression in patients with polycystic ovary syndrome: a systematic evaluation and meta-analysis

Background Acupuncture is increasingly utilized to address anxiety and depression in polycystic ovary syndrome (PCOS), yet evidence for non-pharmacological interventions remains limited. This study aimed to rigorously evaluate the efficacy and safety of acupuncture in alleviating anxiety and depression among women with PCOS, while exploring its potential mechanisms. Methods Eight Chinese/English databases (CNKI, Web of Science, PubMed, Embase, etc.) were searched from inception to March 1, 2025. Two investigators independently screened studies, extracted data, and assessed quality via the Cochrane risk-of-bias tool. The meta-analyses were performed with RevMan 5.4. Additionally, data mining methods were used, including frequency statistics to analyze the frequency of acupuncture points and the meridians involved. Results Twelve RCTs ( n = 2,127 patients; acupuncture = 1,059, control = 1,068) were included. Compared with the control, acupuncture significantly reduced anxiety scores [MD = −6.42, 95% CI (−8.91, −3.56); p < 0.00001] and depression scores [MD = −5.89, 95% CI (−9.01, −2.78); p = 0.0002] versus controls. Acupuncture also improved testosterone [MD = −0.05, 95% CI (−0.11, 0.00); p = 0.05], BMI [MD = −0.70, 95% CI (−1.19, −0.21); p = 0.005], and the waist-hip ratio [MD = −0.06, 95% CI (−0.11, −0.01); p = 0.03], with no significant adverse effects [OR = 0.08, 95% CI (0.01, 0.81); p = 0.03]. The effects on insulin resistance were not significant [MD = −0.41, 95% CI (−1.18, 0.37); p = 0.31]. Data mining revealed that Foot Taiyin Spleen Meridian (SP), Conception Vessel (CV), and Foot Yangming Stomach Meridian (ST) were the most frequently used, and the most commonly used combination of points included SP6, LR3, and ST36. Conclusion Acupuncture, particularly manual and short-term protocols, is a safe and effective adjunct for reducing anxiety and depression in PCOS. These benefits may be mediated via modulation of androgen levels, adiposity, and neuroendocrine pathways. Nevertheless, conclusions are limited by sample size, methodological heterogeneity, and inadequate adverse event reporting. Higher-quality RCTs are needed to confirm the safety and efficacy of these methods. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251000646 , Identifier CRD420251000646.