Background: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder in women that affects both reproductive and metabolic systems and is characterized by insulin resistance and other metabolic disturbances. Therefore, the purpose of the study is to evaluate the clinical and metabolic characteristics of Polycystic Ovary Syndrome (PCOS) patients, focusing on anthropometry, hirsutism, and insulin resistance. Aim of the study: The aim of the study was to evaluate the clinical and metabolic characteristics of Polycystic Ovary Syndrome (PCOS) patients, focusing on anthropometry, hirsutism, and insulin resistance. Methods: This comparative cross-sectional study at the Department of Obstetrics and Gynecology, ICMH, Dhaka (Oct 2022–Sep 2023) included 66 women aged 18–35 years with PCOS (Rotterdam criteria), grouped by ovarian volume (>10 cc vs ≤10 cc). Anthropometric, clinical, and metabolic parameters—including BMI, waist-to-hip ratio, Ferriman–Gallwey score, fasting glucose, insulin, and HOMA-IR—were assessed. Data were analyzed using SPSS 27, with p < 0.05 considered significant. Results: Among 66 PCOS patients, Group A showed higher BMI (27.49 vs. 26.07 kg/m²) and HOMA-IR (4.83 vs. 3.59; p = 0.012). A strong correlation was found between HOMA-IR and ovarian volume (r = 0.685, p < 0.001). High insulin resistance (≥3.8) was more frequent in Group A (67.6% vs. 21.9%), conferring 7.5-fold higher odds of enlarged ovarian volume (OR = 7.47, 95% CI = 2.48–22.52). Conclusion: PCOS in women is closely associated with overweight, hirsutism, and insulin resistance, which in turn correlates with increased ovarian volume.