Aim: This study aimed to evaluate the effects of oral contraceptive pills (OCPs) and metformin on metabolic and endocrine parameters in patients with polycystic ovary syndrome (PCOS). The objective was to compare their impact on hormonal regulation, insulin sensitivity, lipid profile, and clinical symptoms such as menstrual irregularities, acne, and hirsutism. Materials and Methods: A prospective interventional study was conducted at the Department of Obstetrics and Gynecology, A.N.M.M.C.H, Gaya, from January 2023 to December 2024. A total of 100 women (aged 18-35 years) diagnosed with PCOS using the Rotterdam criteria (2003) were randomly divided into two groups: Group A (OCPs, n=50) received a combination pill of ethinyl estradiol (30 mcg) and cyproterone acetate (2 mg) daily, and Group B (Metformin, n=50) received metformin 1500 mg/day in divided doses for six months. Endocrine (LH, FSH, testosterone, DHEA-S), metabolic (FBG, insulin, HOMA-IR, lipid profile), and clinical parameters (menstrual regularity, acne, hirsutism, ovarian morphology) were assessed at baseline and post-intervention. Data were analyzed using SPSS 25.0, and p<0.05 was considered statistically significant. Results: Both treatments significantly improved hormonal and metabolic parameters, but their effects varied. OCPs were more effective in reducing LH (12.5 to 8.2 mIU/mL, p=0.002), testosterone (65.4 to 45.3 ng/dL, p=0.003), and DHEA-S (p=0.02), leading to better menstrual regulation (80% vs. 65%, p=0.001) and improvements in acne (p=0.02) and hirsutism (p=0.03). In contrast, Metformin was superior in lowering fasting insulin (16.1 to 12.8 µIU/mL, p=0.002), HOMA-IR (3.89 to 2.95, p=0.001), and LDL cholesterol (p=0.01), demonstrating greater metabolic benefits. Both groups showed a significant reduction in ovarian volume (OCP: 10.5 to 8.2 mL, Metformin: 10.7 to 9.4 mL, p=0.03) and follicle count (p=0.01). Conclusion: This study concludes that OCPs are more effective in regulating menstrual cycles, reducing hyperandrogenism, and improving ovarian morphology, whereas Metformin is superior in enhancing insulin sensitivity and metabolic parameters in PCOS patients. A combination approach may provide a more comprehensive management strategy, addressing both endocrine and metabolic dysfunctions in PCOS.