Abstract Background Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine disorders among women of reproductive age, with well-documented adverse effects on physical, emotional, and social functioning. Despite its growing burden in South Asia, data on health-related quality of life (HRQoL) among Bangladeshi women with PCOS remain scarce. Methods A descriptive cross-sectional study was conducted between April and September 2024 among women attending the outpatient Gynecology and Obstetrics departments of four tertiary care hospitals in Dhaka, Bangladesh. A total of 331 women with a confirmed diagnosis of PCOS were enrolled using purposive sampling. Sociodemographic and reproductive data were collected through semi-structured interviews, and HRQoL was assessed using the validated Polycystic Ovary Syndrome Quality of Life (PCOSQOL-47) questionnaire scored on a 5-point Likert scale. Associations between participant characteristics and QoL outcomes were examined using chi-square and Fisher's exact tests. Crude odds ratios (ORs) and prevalence ratios (PRs) with 95% confidence intervals (CIs) were computed to quantify the strength of association. Statistical significance was set at P 30 years, those who were overweight or obese, homemakers, service workers, and those with regular menstrual cycles or who had been pregnant ≤ 2 times all demonstrated 100% prevalence of poor QoL. Marital status was not significantly associated with QoL (P = 0.397). Conclusion PCOS substantially impairs HRQoL among Bangladeshi women, particularly those who are older, have higher BMI, lower educational attainment, or experience reproductive difficulties. BMI represents the most modifiable and impactful determinant of QoL in this population. Targeted, multidisciplinary interventions addressing both clinical and psychosocial dimensions of PCOS are urgently needed.