Analysis of over 103 million women's health records reveals that 20.67% of those with polycystic ovary syndrome (PCOS) experience significant pain, with Black women showing the highest prevalence at 32.70%. The study identified 597,638 women with PCOS across 120 healthcare organizations, demonstrating that pain substantially increases risks for infertility, ovarian cysts, type 2 diabetes, and fatty liver disease. Importantly, PCOS medications appeared to reduce pain diagnoses after treatment. This massive dataset analysis fills a critical knowledge gap, as pain symptoms in PCOS have been historically underexplored despite affecting one in five patients. The findings suggest pain could serve as an early warning system for future complications, particularly given the stark racial disparities observed. However, as a preprint awaiting peer review, these conclusions remain preliminary. The retrospective design also limits causal interpretations—pain could be either a symptom or risk factor. Nevertheless, this represents one of the largest investigations into PCOS pain patterns, potentially reshaping how clinicians assess and monitor the estimated 116 million women worldwide living with this complex endocrine disorder.