PCOS is the commonest endocrine disorder of young women. It has appreciable impact on wellbeing and quality of life, fertility and reproduction, and long term metabolic and cancer risks. Acknowledged a ‘condition of our times’, there was no data from Asia until recently. South Asians have early manifestation with more severe symptoms than white Europeans. Young affected Asians have significantly greater insulin resistance than older white Europeans; with approximately a third having the metabolic syndrome. Central obesity, hypertension and abnormal lipids bear greater significance than BMI; a new dimension to the South Asian phenotype. This highlights their propensity to central fat accumulation. Advancing age impacts significantly on metabolic problems, while gestational diabetes is closely interwoven. Studies in China and Thailand also demonstrate ethnic variation with less overt hirsutism.