Abstract：Objective：To systematically evaluate the clinical efficacy and safety of acupuncture and moxibustion combined with Estradiol Valerate in the treatment of patients with thin endometrium （TE）. Methods：Clinical literature on acupuncture and moxibustion combined with Estradiol Valerate in the treatment of TE patients was retrieved from databases including PubMed， the Excerpta Medica Database （Embase）， the Cochrane Library， China National Knowledge Infrastructure （CNKI）， Wanfang Data Knowledge Service Platform （Wanfang）， China Science and Technology Journal Database （VIP）， and China Biology Medicine disc （CBMdisc） from their inception to May 31， 2025. The included studies were assessed for risk of bias and quality according to the Cochrane Handbook. Metaanalysis was performed using RevMan 5.3 and Stata 14.0 software. Results：A total of 9 studies involving 540 patients were included. The Meta-analysis results showed that the combination of acupuncture and moxibustion with Estradiol Valerate was superior to Estradiol Valerate alone in improving endometrial thickness [SMD=1.43， 95% CI （0.94， 1.91）， Z=5.771， P＜0.001]， pregnancy rate [OR=2.74， 95% CI （1.69 to 4.45）， Z=4.078， P=0.001]， uterine artery resistance index [SMD=-0.62，95% CI （-1.03，-0.22），Z=-3.057，P=0.002]，and uterine artery pulsatility index [SMD=-1.49，95%CI （-2.33，-0.66），Z=-3.498，P=0.001]，with all differences being significant. Subgroup analysis yielded consistent conclusions. In terms of safety，acupuncture and moxibustion has a favorable safety profile. No serious adverse reactions have been observed. Conclusion：Acupuncture and moxibustion combined with Estradiol Valerate can improve endometrial thickness and pregnancy rates in TE patients， enhance uterine artery blood flow parameters，and demonstrates an overall favorable safety profile.