Objectives: This study aimed to assess the clinical evidence supporting the use of acupuncture (AC) for premenstrual syndrome (PMS). Methods: We searched randomized controlled trials (RCTs) that used AC for PMS in 9 databases (PubMed, EMBASE, Cochrane Library, CINAHL, CNKI, CiNii, SCIENCE ON, KoreaMed, OASIS) from their inception to July 2022. Results: We identified 1,168 studies, of which 15 RCTs met the inclusion criteria. The risk of bias in the included studies was relatively unclear or high. Meta-analysis of 3 RCTs showed that the AC group had a significantly higher effective rate than the Medroxyprogesterone group (RR 1.48, 95% CI (1.23, 1.78), p<0.0001). Meta-analysis of 2 RCTs showed that there was no statistically significant difference between the AC group and the Sham AC group in the effective rate (RR 4.72, 95% CI (0.88, 25.36), p=0.07). In a review of individual studies, the AC group was more effective than the control group in terms of the effective rate, symptom scale, quality of life, adverse events, and recurrence rate. Conclusions: The AC group was more effective than general treatments groups such as sham AC, western medicine, and dietary supplements, and there were no serious adverse events. However, the evidence on the effectiveness and safety of acupuncture for PMS was inconclusive due to the small number of included studies and low quality. Therefore, systematic reviews based on more rigorously designed randomized clinical trials are needed in the future to properly evaluate the effect of AC on PMS.