Background: Ovarian neoplasms are a significant clinical challenge due to their diverse histopathological types and frequent late-stage diagnosis. These malignancies are among the most lethal gynecological cancers due to their asymptomatic nature in the early stages and the lack of effective screening strategies. Methods: This cross-sectional study was conducted at a tertiary care hospital, including female patients diagnosed with ovarian neoplasms who underwent surgical treatment. Data were collected on demographic, clinical, and pathological variables, focusing on the prevalence, types, and outcomes of ovarian neoplasms. Statistical analysis was performed using SPSS version 25.0, with results presented in tables and figures. Chi-square test was used to check the association between categorical variables and p value less than 0.05 was considered significant. Results: The study analysed 356 cases of ovarian lesions, among which 144 (40.45%) were cases of ovarian neoplasms. The mean age of patients was 41.13 years, with the highest frequency in the 28-38 age group (25.69%). Benign lesions accounted for 71.53% of cases, malignant lesions for 24.31%, and borderline lesions for 4.17%. The majority of lesions were left-sided (44.44%). Serous tumors were the most common (54.86%), followed by mucinous tumors (15.97%) and germ cell tumors (11.11%). A significant association was found between laterality and lesion type (P < 0.0001). Conclusion: This comprehensive analysis highlights the significant prevalence of ovarian neoplasms in women of reproductive age, with serous tumors being the most common subtype. The study underscores the importance of targeted screening and fertility-preserving surgical interventions. The significant association between bilateral lesions and malignancy emphasizes the need for careful evaluation of such cases.