Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by a spectrum of reproductive and metabolic abnormalities, including menstrual irregularity, hyperandrogenism, and polycystic ovarian morphology. Clinical manifestations vary widely and are influenced by factors such as body mass index (BMI) and hormonal imbalances. Understanding the clinical and endocrine profile of women with PCOS in tertiary care settings can aid early recognition and tailored management. Methods: This cross-sectional observational study enrolled 150 women of reproductive age (18–45 years) diagnosed with PCOS based on the Rotterdam criteria. Participants attended the Obstetrics and Gynecology Department at a tertiary care hospital between January 2024 and December 2024. Demographic data, clinical presentations (e.g., menstrual pattern, hirsutism, acne, acanthosis nigricans), and family history were recorded. BMI was calculated and participants were categorized accordingly. Transvaginal or transabdominal ultrasonography was performed to confirm polycystic ovarian morphology. Fasting blood samples were collected and hormonal assays included luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH/FSH ratio, total and free testosterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEA-S), prolactin, and thyroid-stimulating hormone (TSH). Data were analyzed using appropriate statistical tests to present descriptive and comparative results. Results: Among the 150 women with PCOS, the mean age was [insert mean age] years. Menstrual irregularity was common, with oligomenorrhea in 54.7 % and amenorrhea in 26.7 % of participants. Normal BMI was observed in 46.7 % of women, while 33.3 % were overweight and 20.0 % were obese. Hirsutism, acne, and acanthosis nigricans were observed in 48.7 %, 45.3 %, and 26.7 % of cases, respectively. Ultrasonography confirmed bilateral polycystic ovarian morphology in 86.7 % of participants. Mean hormonal values were: LH 12.4 ± 5.6 mIU/mL, FSH 6.3 ± 3.2 mIU/mL, and LH/FSH ratio 2.1 ± 0.9. Elevated LH was present in 61.3 % of women, and an increased LH/FSH ratio (>2) in 52.0 %. Elevated total and free testosterone levels were observed in 32.0 % and 41.3 %, respectively. Reduced SHBG occurred in 36.0 %, elevated prolactin in 12.0 %, and subclinical hypothyroidism (TSH >4.0 µIU/mL) in 13.3 %. Conclusions: Women with PCOS attending a tertiary care hospital exhibited a wide range of clinical and endocrine abnormalities, with menstrual irregularity and hyperandrogenism being the most prominent features. A substantial proportion showed hormonal derangements such as elevated LH, increased LH/FSH ratio, and elevated androgens. BMI appeared to influence both clinical presentation and hormonal profiles, underscoring the importance of comprehensive phenotyping in PCOS. These findings highlight the need for individualized management strategies to address reproductive and endocrine dysfunction in PCOS populations.