Background: Polycystic ovary syndrome (PCOS) is connected with metabolic, reproductive, and psychiatric disorders such as depression, anxiety and eating disorders (ED). Gonadotropin-releasing hormone (GnRH) secretion is regulated by neurohormones, such as spexin (SPX). This study aimed at assessing the serum level of spexin in women with PCOS and to evaluate its association with eating disorders, metabolic and reproductive features. Subjects and methods: A case control study was conducted on 80 women; 40 women with PCOS and 40 healthy women as a control group. Serum spexin was assessed by an enzyme-linked immune absorbent assay. Depression, anxiety and ED were assessed using the Structured Clinical Interview for DSM-IV-TR axis I disorders (SCID I), Hospital Anxiety and Depression scale (HADS) and Eating Disorder Examination Questionnaire (EDE-Q). Results: Serum spexin values were lower in the PCOS group (0.62±0.312) compared to the control group (1.16±0.49, p ˂0.001). Prevalence of ED among PCOS group was 32.5% (n=13) vs 15% in the control group (n=6) with binge eating disorder (BED) having the highest prevalence of ED among patients with PCOS. PCOS women with ED had lower values of spexin compared to PCOS women without ED (0.532±0.275 vs 0.747±0.33 respectively, p ˂0.001). There were significant negative correlations between serum spexin and phenotypic features of the PCOS group as well as ED parameters. BMI, depression and anxiety scores were independently correlated with spexin level in PCOS group. Conclusion: PCOS is associated with metabolic and eating disorders in particular BED. Spexin levels were significantly lower in PCOS women and ED and inversely associated with metabolic, reproductive, and eating disorders.