Introduction Patients with polycystic ovary syndrome (PCOS) have a higher risk of developing metabolic syndrome (MetS), as similarities in pathophysiology exist between the two. Adipokines are the key molecules that alter the adipose tissue metabolism and distribution, leading to MetS. This study was conducted to assess the levels of adipokines among patients with PCOS with and without MetS and to establish the role of adipokines as an early predictor for the development of MetS in PCOS. Materials and methods In this monocentric, tertiary hospital-based study, 144 patients with PCOS were selected and classified according to Rotterdam criteria and screened for MetS. Patients were grouped into MetS and non-MetS categories based on the presence of MetS. Adipokine levels (adiponectin, leptin, and resistin) were measured and compared, along with other biochemical and anthropological parameters. Data were analyzed using Jamovi statistical software, version 2.3 (Retrieved from https://www.jamovi.org), using an independent samples t-test and multinomial regression analysis. Results Out of the 144 patients included in the study, 58 were diagnosed with MetS and grouped as MetS. The prevalence of MetS was maximum among the non-PCO (O+HA) phenotype (53 out of 58). Significant differences (p<
0.002) in adipokines were observed between the MetS and non-MetS groups. Adiponectin, leptin, and resistin were found to have a significant role as predictors of MetS at an early stage of development of the syndrome, along with other common predictors. However, in later stages, fasting, blood glucose, waist circumference, and triglycerides remain significant predictors. Conclusion The present study reports a high prevalence of MetS among PCOS cases (40.27%). Altered adipokine levels may be significantly associated with the early stages of MetS development and may be used as an early diagnostic tool for the management of MetS in PCOS. Therefore, the measurement of adipokines during preliminary investigations may be used as an early diagnostic tool for the management of MetS in PCOS.