<bold>Background:</bold> Perimenopausal insomnia is a chronic physical and mental health disorder that plagues women. However, there are no systematic reviews or meta-analyses on the treatment of perimenopausal insomnia with acupuncture alone. Therefore, we conducted a meta-analysis to assess the efficacy and safety of acupuncture alone in improving perimenopausal insomnia. <bold>Methods:</bold> This study searched for randomized controlled trials on acupuncture treatment for perimenopausal insomnia from seven major literature databases in both Chinese and English: Web of Science, PubMed, the Cochrane Library, Embase, China National Knowledge Infrastructure, VIP database, and Wan-fang database. The quality of the studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was conducted using Rev Man 5.4 software. <bold>Results:</bold> The study comprised nine randomized controlled trials involving 968 people. The results showed that acupuncture was superior to the control group in improving the effective rate (OR: 3.30; 95% CI: 2.18-4.98; p < 0.00001), PSQI score (MD: -3.26; 95% CI: -4.62- -1.90; p < 0.00001), FSH (MD: -11.01; 95% CI: -15.39- -6.63; p < 0.00001), KMI score (p < 0.05), 5-HT (p < 0.05), NE (p < 0.05), MENQOL score (p < 0.05), early-wake score (p < 0.05), sleep actigraphy monitoring (p < 0.05), and Traditional Chinese Medicine symptom scores (p < 0.05) in patients with menopausal insomnia. The two groups had no significant differences in regulating serum E2 (MD: 7.70; 95% CI: 2.20-13.19; p = 0.06) and LH levels (MD: -5.42; 95% CI: -9.46- -1.37; p = 0.009). <bold>Conclusion:</bold> Acupuncture treatment is significantly effective for patients with perimenopausal insomnia. However, large-sample, multi-center, long-term follow-up trials should be conducted to obtain more reliable results. Considering the particularities of acupuncture treatment, actively constructing a real-world acupuncture clinical research paradigm will bring more authentic, rich, and practical research outcomes to clinical practitioners.