Objective To study the association between endocrine disturbances and metabolic complications in women seeking gynecologic care. Design Retrospective study, cluster analysis. Setting Outpatient clinic, university medical center. Patient(s) 573 women, including 384 at low risk and 189 at high risk of cardiometabolic disease. Intervention(s) None. Main Outcome Measure(s) Cardiovascular and metabolic parameters and clinical and biochemical characteristics. Result(s) Risk factors for metabolic disease are associated with a low age of menarche, high levels of high-sensitivity C-reactive protein and liver enzymes, and low levels of sex hormone-binding globulin. Overweight/obese status, polycystic ovary syndrome, oligo/amenorrhea, and hyperandrogenism were found to increase the risk of cardiometabolic disease. However, hyperprolactinemia and premature ovarian failure were not associated with the risk of cardiometabolic disease. In terms of androgens, the serum total testosterone level and free androgen index but not androstenedione or dehydroepiandrosterone sulfate (DHEAS) were associated with cardiometabolic risk. Conclusion(s) Although polycystic ovary syndrome is associated with metabolic risk, obesity was the major determinant of cardiometabolic disturbances in reproductive-aged women. Hyperprolactinemia and premature ovarian failure were not associated with the risk of cardiovascular and metabolic diseases. Clinical Trial Registration Number NCT01826357.