Background Acupuncture and non-steroidal anti-inflammatory drugs (NSAIDs) are used frequently to treat primary dysmenorrhoea. However, it is unclear whether this treatment greatly reduces the risk of primary dysmenorrhoea. Methods Eight databases were searched up to January 2018. Pair-wise and network meta-analyses were conducted to synthesize data from eligible studies. Results Seventeen randomized controlled trials were included. The following acupuncture types showed more efficacy than NSAIDs in reducing primary dysmenorrhoea risk: traditional acupuncture (odds ratio [OR]=6.70, 95% confidence interval [CI] 2.60-20.0), eye acupuncture (OR=3.50, 95% CI 1.40-8.90), wrist-ankle acupuncture (OR=6.00, 95% CI 1.30-32.0), superficial acupuncture (OR= 5.10, 95% CI 1.20-26.0), moxibustion (OR=7.70, 95% CI 2.90-25.0), electroacupuncture (OR=23.0, 95% CI 4.80-130), ear acupuncture (OR=13.0, 95% CI 2.80-100) and abdominal acupuncture (OR=5.30, 95% CI 2.10-16.0). Surface under the cumulative ranking curve values were traditional acupuncture (53.0%), eye acupuncture (22.0%), wrist-ankle acupuncture (81.5%), superficial acupuncture (50.0%), moxibustion (57.8%), electroacupuncture (99.9%), ear acupuncture (41.6%) and abdominal acupuncture (44.1%). Conclusion Acupuncture is more efficacious than NSAIDs in reducing primary dysmenorrhoea risk. Acupuncture, particularly electroacupuncture, can decrease the risk of primary dysmenorrhoea.