Background: PCOS, or polycystic ovarian syndrome, is a prevalent endocrine disorder affecting women in the reproductive age range. The present study was conducted to evaluate the effect of oral contraceptive pills (OCP) and metformin on metabolic and endocrine parameters in PCOS. Materials & Methods: The study was conducted at Nalanda Medical College and Hospital, Patna from December 2021 to December 2023. 80 female patients with PCOSwere divided into 2 groups. Group I (40) received lifestyle intervention and 500mg oral metformin and group II received lifestyle intervention, and was given OCP (fixed dose combination of ethinyl estradiol 50 micrograms and cyproterone acetate 2 milligrams per day for six months). Parameters were evaluated at baseline, 2nd month and 6th month. Results: At baseline, 2 months and 6 months mean weight (kg) in group I was 58.2, 57.6 and 54.1 and in group II was 50.3, 51.3 and 52.8 respectively. BMI (kg/m2) in group I was 29.4, 28.1 and 26.4 and in group II was 24.8, 25.3 and 26.1. The mean waist/hip ratio in group I was 0.92, 0.91 and 0.89 and in group II was 0.80, 0.82 and 0.84 respectively. The difference was significant (P< 0.05). At baseline, 2 months and 6 months, FBS (mmol/L) in group I was 5.6, 4.4 and 4.9 and in group II was 4.2, 4.3 and 4.8 respectively. PPBS (mmol/L) in group I was 5.8, 5.4 and 5.1 and in group II was 5.1, 5.3 and 5.7. HbA1c (%) in group I was 7.4, 7.2 and 6.8 and in group II was 5.7, 5.4 and 5.2. Total cholesterol (mmol/L) in group I was 5.6, 5.8 and 5.9 and in group II was 5.3, 5.6 and 5.1. TG (mmol/L) in group I was 2.7, 2.8 and 2.5 and in group II was 2.2, 2.1 and 2.1. HDL (mmol/L) in group I was 0.90, 0.92 and 0.94 and in group II was 1.2, 1.4 and 1.5. LDL (mmol/L) in group I was 4.5, 4.6 and 4.6 and in group II was 3.2, 3.4 and 3.4 respectively. The difference was significant (P< 0.05). At baseline, 2 months and 6 months, the mean TSH (IU/L) in group I was 3.7, 3.9 and 3.6 and in group II was 3.6, 3.5 and 3.6 respectively. Testosterone (mmol/L) in group I was 2.6, 2.4 and 2.2 and in group II was 2.9, 2.9 and 2.2. Prolactin (ng/mL) in group I was 19.4, 19.2 and 18.5 and in group II was 18.6, 18.4 and 18.5 respectively. Conclusion: For PCOS patients, oral metformin and oral contraceptive tablets are both effective therapeutic options that significantly reduce menstruation symptoms within six months of starting therapy.