By virtue of insulin resistance being the common etiology for PCOS and Metabolic Syndrome, the cardio metabolic risks of these two syndromes are shared. The usual concerns of a PCOS patient are cosmetic or reproductive. However, there are more serious concerns past the reproductive age. Early treatment of insulin resistance, hypertension, and hyperlipidaemia reduces the long-term risk. This review highlights the unhealthy association of Metabolic Syndrome with PCOS, and emphasizes on early diagnosis, patient education and a long term follow up beyond reproductive age to prevent the co morbidities.