Background ‘Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, often associated with metabolic disturbances, including insulin resistance and dyslipidemia’. Metformin, an insulin-sensitizing agent, is frequently used to manage metabolic dysfunction in PCOS, but its effects on lipid metabolism remain an area of interest. This study evaluates the ‘impact of Metformin on lipid parameters in women with PCOS’. Methods A prospective interventional study was conducted at Jinnah Medical College, Peshawar, from January 2023 to January 2024. A total of 103 women diagnosed with PCOS based on the Rotterdam criteria were included. Participants received Metformin therapy for three months, and their metabolic parameters were assessed before and after treatment. Fasting blood glucose, fasting insulin, HOMA-IR, and lipid profile (total cholesterol, LDL-C, HDL-C, triglycerides, and VLDL) were measured using standard biochemical methods. Changes in lipid and metabolic parameters were analyzed using paired statistical tests. Results Following Metformin therapy, significant improvements were observed in lipid metabolism. LDL-C levels decreased from 132.6 mg/dL to 118.2 mg/dL (p<0.001), ‘while total cholesterol dropped from 201.8 mg/dL to 184.5 mg/dL (p<0.001). HDL-C increased from 39.5 mg/dL to 44.8 mg/dL (p<0.001), and triglycerides were reduced from 172.4 mg/dL to 146.9 mg/dL (p<0.001)’. Additionally, fasting insulin levels and HOMA-IR showed significant reductions, indicating improved insulin sensitivity. There was also a notable improvement in menstrual cycle regularity and a reduction in hyperandrogenic symptoms. Conclusion Metformin therapy positively influences lipid metabolism, insulin resistance, and hormonal balance in women with PCOS. By lowering LDL-C and triglycerides while increasing HDL-C, Metformin contributes to a healthier lipid profile, potentially reducing long-term cardiovascular risks in this population. ‘These findings support the role of Metformin as an effective metabolic therapy in PCOS management’. Further research is recommended to explore its long-term effects on cardiovascular outcomes.