The invention provides a megestrol acetate preparation method. The method comprises the steps that 6-keto-17a-acetoxy progesterone serves as the raw material, the raw material is dissolved into an organic solvent, in the presence of triethyl orthoformate, a catalytic reaction is conducted with glycolic acid, and double ketals are obtained; the double ketals are dissolved into an organic solvent, a Grignard reaction is conducted with a Grignard reagent, after the reaction is completed, under the strong acid effect, Grignard hydrolysis is conducted, deprotection and dehydration are conducted simultaneously, and a crude megestrol acetate product is synthesized through a two-step reaction; the crude product is subjected to decoloration and recrystallization through activated carbon, and a megestrol acetate product is obtained, wherein the HPLC content ranges from 99.0% to 99.5%, the melting point ranges from 213 DEG C to 220 DEG C, and the two-step synthetic weight total yield ranges from 80% to 85%. Accordingly, compared with a traditional method, the synthetic route is short, the technological operation is easy and convenient, production is economical and environmentally friendly, the synthetic total yield is increased by 30% or above compared with that of the traditional method, and the production cost is lowered by 30%-35%; the solvents used in the technology can be recycled and applied mechanically, economy and environmental friendliness are achieved, and the method is very beneficial to industrial production.