Perimenopause represents a transition period lasting about 5 years before the permanent cessation of spontaneous menses. During this transition, the emphasis of clinical care changes. Although women still need effective contraception during perimenopause, issues including loss of bone mineral density, menstrual cycle changes, and vasomotor instability also need to be addressed. Hormone replacement therapy is not the first-line treatment for women with symptomatic perimenopause because hormone replacement therapy neither suppresses ovulation nor provides contraception; also, it will not prevent and in fact may aggravate unpredictable perimenopausal bleeding. Oral contraceptives offer many benefits for healthy, nonsmoking, perimenopausal women. Oral contraceptive use by women in their 40s has been found to decrease the risk of postmenopausal hip fractures and regularize menses in women with dysfunctional uterine bleeding, reducing the need for surgical intervention for benign menstrual conditions. Use of oral contraceptives also can reduce long-term risk of endometrial and ovarian cancers. There is also good evidence that oral contraceptives relieve vasomotor symptoms in perimenopausal women. Oral contraceptives can be viewed as a strategy not only to improve perimenopausal symptoms, provide effective contraception, and reduce some long-term health risks, but also to enhance the quality of life for perimenopausal women.