The WP_Options table has around 300000 rows and is sitting at 220Mib. I'm pretty new to Databases so is this rather large or ok?
those are too much, what you have in there? you need to clear those up.
are you sure 200 mb is wp_options table only?
there can be some lame tables created by various plugins like statpress etc which can take space fast in db. please reconfirm if this is the case by loggin into phpmyadmin.