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Particularly in areas like Bihar, the prevalent endocrine disorder known as polycystic ovarian syndrome (PCOS) affects women’s health-related quality of life (HRQOL). This study examined the PCOS prevalence, clinical characteristics, and HRQOL effects in Bihar and determined a significant reduction in HRQOL due to problems such as irregular periods, obesity, and infertility. Cross-sectional studies in Patna and Gaya included 560 women (300 Gaya, 160 from Patna, 200 controls), and it was PCOS. Diagnosed using the Rotterdam criteria after being evaluated with the PCOSQ questionnaire and the SF-36. Results showed that PCOS patients scored low points in all HRQOL domains, infertility and obesity were important predictors of poor outcomes, and urban women had more prominent hormonal imbalances. These results show how crucial it is to provide medical and mental health care to women with PCOS in Bihar.