OBJECTIVE: To compare health-related quality-of-life outcomes and sexual functioning among premenopausal women who underwent bilateral salpingo-oophorectomy (BSO) versus ovarian conservation at the time of hysterectomy. METHODS: This is a secondary data analysis of premenopausal women who underwent hysterectomy for benign gynecologic disease in the Medicine or Surgery and the Total or Supracervical Hysterectomy randomized trials. Bilateral salpingo-oophorectomy was performed at the patients' requests or to treat intraoperative ovarian pathology. Health-related quality-of-life outcomes and sexual functioning were assessed using the Medical Outcomes Study SF-36, Sexual Problems Scales, and several other measures at 4 weeks, 6 months, and 2 years after hysterectomy. RESULTS: Mean age at hysterectomy was higher for the 49 women who underwent BSO compared with the 112 women with ovarian conservation (45 versus 40, P<.001). At 6 months, the BSO group demonstrated less improvement than women with ovarian conservation on scales for body image (2 versus 14, P=.01), sleep problems (4 versus 16, P<.01), and the SF-36 Mental Component Summary (4 versus 10, P=.03). There were no differences in any measure of sexual functioning between the groups. Hot flushes, urinary incontinence, and pelvic pain were similar in both groups. At 2-year follow-up, all measures of health-related quality-of-life and sexual functioning appeared similar by BSO status. CONCLUSION: Women who underwent BSO had less improvement in some aspects of health-related quality of life within the first 6 months following hysterectomy compared to women with ovarian conservation. However, these differences were not apparent 2 years after surgery. LEVEL OF EVIDENCE: II.