Background <p>Acupuncture has been widely applied to polycystic ovarian syndrome (PCOS) patients. This network meta-analysis (NMA) aims to compare the effects of different acupuncture methods on PCOS from the aspects of hyperandrogenism, metabolic status, sexual hormone disturbance, and infertility.</p> Methods <p>We searched eight electronic databases for randomized controlled trials on different acupuncture methods vs. placebo or standard treatment by the end of 30 October, 2023. Stata17 and R 4.5.2 were used for a Bayesian NMA, and Cochrane RoB 2.0 tool for the methodological quality assessment of the included studies.</p> Results <p>A total of 59 studies (5937 participants) were included. In terms of hyperandrogenism, acupuncture greatly reduced testosterone levels in PCOS patients compared with medicine (mean difference(MD)): 0.69; 95% credible interval [0.35, 1.03]). Based on surface under the cumulative ranking curve (SUCRA), acupoint catgut embedding (ACE) was the most recommended in decreasing testosterone levels(SUCRA = 81.7%). Compared with placebo, electro-acupuncture (E-acupuncture) was significantly effective in decreasing Ferriman-Gallwey scores in PCOS patients (MD: 1.52; 95% CrI [0.50, 2.53]), and it was also the preferred choice for reducing Ferriman-Gallwey scores (SUCRA = 84.9%). In terms of metabolic status, ACE was regard the most recommended in reducing body mass index (SUCRA = 90.9%) and waist hip rate (SUCRA = 95.3%); acupuncture was considered as the top preferred option in reducing triglyceride (SUCRA = 79.3%) and high-density lipoprotein (SUCRA = 54.8%); E-acupuncture was possibly the preferred choice for reducing low-density lipoprotein (SUCRA = 75.2%) and fasting blood glucose (SUCRA = 64.6%), and medicine was the preferred choice for reducing homeostasis model assessment of insulin resistance. For sexual hormone disturbance, ACE served as the most recommended option in reducing luteinizing hormone (LH) (SUCRA = 73.3%) and LH/follicle-stimulating hormone(FSH) ratio (SUCRA = 80.9%). For infertility, acupuncture acted as the preferred choice in increasing the pregnancy rate (SUCRA = 76.6%). Sensitivity analyses indicated that the results were generally robust.</p> Conclusions <p>No single acupuncture method is the optimal method for all indicators in PCOS patients. Clinically, clinicians may select acupuncture treatment based on patients’ primary clinical concerns, acknowledging the limitations of current evidence and individualizing treatment decisions. These findings remain to be further verified by rigorously designed studies due to limitations of existing clinical studies and evidence.</p>