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Objectives This study aimed to evaluate the prevalence and metabolic, hormonal and clinical characteristics of metabolic syndrome among women with polycystic ovary syndrome (PCOS) in the Oran region (western Algeria).Design Cross-sectional study.Setting Outpatient endocrinology and gynaecology services in the Oran region, western Algeria.Participants A total of 313 women aged 16–45 years diagnosed with PCOS according to the Rotterdam 2004 criteria.Main outcomes Prevalence of metabolic syndrome and differences in anthropometric (body mass index (BMI)), metabolic (fasting glucose and lipid profile), hormonal (gonadotropins, androgens, anti-Müllerian hormone (AMH), progesterone, vitamin D) and clinical features (hyperandrogenism, menstrual irregularity, infertility) between women with and without metabolic syndrome.Results Of the 313 participants, 181 (57.9%) met the criteria for metabolic syndrome. These women had significantly higher BMI (26.70±5.93 vs 25.06±6.47 kg/m²; p=0.004), elevated fasting glucose (133.43±28.52 vs 105.41±28.54 mg/dL; p<0.0001) and triglycerides (p<0.0001), but lower high-density lipoprotein (HDL)-C (p<0.0001). They also exhibited elevated luteinising hormone (LH), LH/follicle-stimulating hormone ratio, total testosterone and AMH levels, and reduced progesterone and vitamin D concentrations (all p<0.0001). Clinical hyperandrogenism, menstrual irregularity and secondary infertility were significantly more prevalent in this group.Conclusion More than half of women with PCOS exhibited metabolic syndrome, characterised by obesity, dyslipidaemia, insulin resistance and vitamin D deficiency. These findings highlight the need for early metabolic screening and holistic management in women with PCOS to reduce long-term cardiovascular and reproductive risks.