Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder in which insulin resistance (IR) drives reproductive and metabolic abnormalities. Baseline characterization of clinical, hormonal, and IR profiles is critical for personalized management. Objective: To establish baseline clinical, hormonal, and IR profiles in women with PCOS and examine correlations between IR severity and phenotypic features. Methods: This randomized controlled trial enrolled 90 women with PCOS (Rotterdam 2003 criteria) and IR (HOMA-IR >2.0) aged 18–40 years at BSMMU, Dhaka, Bangladesh (July 2023–June 2024). Clinical, hormonal, and metabolic parameters were assessed. Correlations with HOMA-IR and comparisons between mild-moderate (HOMA-IR 2.1–3.5) and severe IR (>3.5) groups were performed. Results: Mean age was 25.3±3.7 years; mean BMI 26.1±2.5 kg/m². Oligomenorrhea (96.7%), hirsutism (90.0%), acanthosis nigricans (73.3%), and primary infertility (81.1%) were common. Hormonal profile showed elevated LH/FSH ratio (1.72±0.59), elevated total testosterone (2.8±0.9 nmol/L), elevated free androgen index (10.5±4.2), and low SHBG (28.4±8.6 nmol/L). Mean HOMA-IR was 3.46±0.96 despite normal fasting glucose. HOMA-IR correlated positively with BMI (r=0.52), waist circumference (r=0.48), testosterone (r=0.41), and FAI (r=0.46), and negatively with SHBG (r=-0.38), but not with LH or LH/FSH ratio. Severe IR group had significantly higher adiposity and androgens and lower SHBG than mild-moderate IR group, with no difference in gonadotropins. Conclusion: In Bangladeshi women with PCOS, IR severity is associated with greater adiposity and hyperandrogenemia but not with gonadotropin abnormalities. Routine IR assessment is essential for phenotype-guided therapy.