Few guidelines exist for the use of estrogen, particularly low-dose oral contraceptives, during the perimenopausal years. Use of low-dose oral contraceptive pills in women over 35 years of age provides protection against unwanted pregnancy, maintains a stable hormonal environment and decreases abnormal menstrual bleeding. Other noncontraceptive health benefits of oral contraceptives include a reduction in bone loss and protection against iron deficiency anemia, dysmenorrhea, benign breast disease, endometrial cancer and epithelial ovarian cancer. This article discusses potential risks of oral contraceptive use in this age group, as well as recommendations about when and how to change from contraceptive therapy to postmenopausal hormone replacement therapy.