Background: Projected elevation rate of obesity, as feature of metabolic syndrome (MetS) among PCOS women, more likely intoxicated the women’s health and quality of life (HRQoL). Whereas influence of its multifaceted dysfunctional profile on PCOS pathology can better be explained employing advance statistical approach, structural equation modeling (SEM).Methods: PCOS women with MetS (N=500) were recruited to examine the impact of MetS on association of PCOS manifestation and HRQoL, recorded from normal weight, overweight, obese and morbidly obese women.Results: An appreciable (P<0.05) boost in PCOS and MetS parameters was resulted in obese and morbidly obese women compared to normal weighed. Moreover suggested models for obese women delineated the confounding intricacy of variables from each construct and appropriateness was also ascertained via confirmatory factor analysis (CFA) and goodness of fit statistics (χ2/df=1.68, NFI=0.786, CFI=0.897, RMSEA=0.078). While positive significant (0.523, P=0.001) impact of MetS on PCOS but inverse noticeable (-0.196, P=0.042) effects of PCOS on physical satisfaction was examined in morbidly obese women. A close directional association between physical dissatisfaction and mental distress in women was also revealed.Conclusion: In conclusion, metabolically blemished morbidly obese and obese women were found more threatened by PCOS manifestation as well as impaired HRQoL.