Introduction Characterized by a range of symptoms including irregular menstrual cycles, hirsutism, and infertility, polycystic ovarian syndrome (PCOS) also poses substantial metabolic challenges. Among these, dyslipidemia and obesity are particularly concerning due to their long-term implications for cardiovascular health.The present study explores the intricate relationship between lipid profile and body mass index (BMI) in patients with PCOS presenting to the Department of Obstetrics and Gynaecology,King George's Medical University, Lucknow, a tertiary care teaching hospital in Northern India. Methods The present work involves analysis of clinical characteristics of 230 premenopausal women between 18-45 years of age diagnosed with PCOS (according to Rotterdam Criteria). Patientswith conditions such as congenital adrenal hyperplasia; Cushing's syndrome; uncontrolled hypertension, smoking,hypogonadism; using oral contraceptives; pregnant or lactating mothers; smoking or drug addiction; psychiatric illness; and those diagnosed with androgen-secreting tumors were excluded. For each participant, data was collected pertaining to demographics (age, marital status), clinical presentation,height, and weight (for BMI calculation), and total lipid profile comprising of total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C). Thepatients were stratified according to their BMI as per the WHO Asian classification, andPearson's correlation coefficient was calculated to see the correlation between lipid profile and BMI. Results The final analysis was done on 228 patients, with a mean age of25.22 (±4.82) years, and 45.6% were currently married. Among the participants, 28.1% of the participants were overweight, and 42.5% of them classified as obese, while the remaining 29.4% had a BMI in the normal range.The mean (SD) total cholesterol was 172.26 (49.55) mg/dl, and 65 patients (28.5%) had elevated serum cholesterol (≥200 mg/dl). Triglycerides were raised (≥ 150 mg/dl) in a majority of the study participants (n=160, 70.2%). While none of the patients had high VLDL-C, LDL-C was elevated in 52 patients (22.8%). HDL-C levels were lower than the threshold value of 50 mg/dl in 152 participants (66.7%). On performing correlation analysis, a significant negative correlation was noted between HDL-C and BMI in the entire study cohort (r=-0.342, p=0.003). Overweight patientsexhibited a statistically significant positive correlation between triglycerides and BMI (r=2.628, p=0.002). Participants with BMI in the overweight range demonstrated statistically significant correlations with HDL-C (r=-0.497, p=0.017) and triglycerides (r=2.628, p=0.002); and BMI of obese patients significantly correlated with total cholesterol (r=0.301, p=0.037) and triglycerides (r=0.146, p=0.028). Conclusion The findings of the study underscore the multifaceted nature of PCOS, affecting reproductive health as well as metabolic components. The significant correlations between BMI and lipid parameters, specifically, HDL-C, triglycerides, and total cholesterol, highlight the importance of weight management in reducing cardiovascular risks in women with PCOS.