Obesity and insulin resistance (IR) are frequently present in patients with polycystic ovary syndrome (PCOS). Both disorders also play an important role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Accordingly, NAFLD is frequently present in patients with PCOS. In the present review, we summarize the findings of the major studies that assessed the prevalence of NAFLD in patients with PCOS. The factors driving the increased frequency of NAFLD in patients with PCOS are also analyzed. Finally, we discuss the management options of NAFLD in patients with PCOS. In addition to IR, elevated androgen levels and inflammation also appear to play a role in the development and progression of NAFLD in patients with PCOS. Lifestyle changes should represent the cornerstone of management of NAFLD. On the other hand, pharmacotherapy appears to have limited efficacy and questionable safety. Moreover, there are very limited data with the various agents used for the management of NAFLD specifically in patients with PCOS. Accordingly, well-designed studies are clearly needed to evaluate the role of pharmacotherapy in the management of NAFLD in PCOS.