“It’s not about the size of each individual footprint, we should be more concerned about the number of footprints!” By 2015, the total world population will reach six billion. Approximately 50% of pregnancies are unplanned, and these pregnancies are caused by the failure of contraceptive methods, with an increasing proportion of unintended pregnancies starting with women in their forties. Although the average monthly probability of pregnancy decreases by 50% as a woman enters her forties, it is estimated that 80% of women in this age group are still capable of conceiving. The latest age at which a mother has been proven to conceive naturally is 59 years. There are many potential problems associated with pregnancies in women older than 40 years, such as the large proportion of these pregnancies that may be terminated medically or surgically (about one-third) compared to only one-fifth in younger women; there is also an increased risk of spontaneous abortion due to genetic abnormalities. Maternal and perinatal mortality and morbidity in ongoing pregnancies are exacerbated by the presence of pre-eclampsia, preterm birth, growth restriction, placental abruption, and gestational diabetes mellitus. Inadequate pregnancy health education for perimenopausal women has been reported, and limited resources are devoted to avoiding unintended pregnancy and transmission of STIs. There are many factors that contribute to failure to use the pill or the method itself, including access, social and cultural factors. The re-reporting of the latest data on compounded oral contraceptive (COC) use being associated with a lower risk of breast cancer has shocked the media world. The headlines in these reports often ignore the fact that long-term COC use reduces the incidence of ovarian and endometrial cancer by half, using COC only for women whose inability to adhere to contraception results in an unintended pregnancy. The three most important factors in determining contraceptive use are acceptability, efficacy, and safety; optimization of these factors relies on ongoing contraceptive research and development, both to optimize existing methods and to investigate new methods and provide more options to help women survive menopause. Improving the benefits of non-contraception Perimenopausal women become delayed, heavy, and distressed, with increased physical and psychological symptoms of premenopause, as well as a combination of menopausal symptoms. As androgen levels decline, so do estrogen levels and sexual desire. This can be further reduced by oral estrogen supplementation to increase the levels of sex hormone binding globulin, which further reduces the bioavailability of androgens. If hormonal contraceptives can improve these processes, it can be reliably used for women in the menopausal transition. Therefore, safety is paramount for most women in their fifties who use these methods after menopause. Advances in perimenopausal hormonal contraceptive methods COC is available to healthy women under 50 years of age who are non-smokers, which significantly improves the options for perimenopausal women. For this age group, 30/35 mcg COCs may be too high a dose. Low doses of COCs containing only 20 micrograms of estrogen reduce their risk of side effects and venous thrombosis (VTE) and do not significantly reduce contraceptive efficacy, but breakthrough bleeding is a recognized side effect of low-dose COCs and may reduce adherence. The latest data suggest that women with previous long-term use of COCs who switched to direct hormone replacement therapy (HRT) were not found to be at additional risk of breast cancer, and this approach was advocated. 17β estradiol COCs may have less impact on metabolic factors compared to COCs with ethinyl estradiol; short half-life estradiol reduces the impact of hepatic first pass elimination on coagulation; and estradiol tablets may be particularly suitable for women older than 40 years who are hovering between the pill and HRT, which would provide a good solution for women who discontinue COCs at age 50. However, for those women who are potentially at risk and older than 50 years, the priority treatment should be to avoid long-term monitoring for venous thrombosis, and arterial-related risks have been reported in ongoing observational trials. The third and fourth generation COCs are diverse depending on the composition of the progestin, which can provide additional health benefits. progestins in COCs, such as hydroxyprogesterone acetate, have been recognized in many countries for their non-contraceptive benefits, such as acne, premenopausal irritability and increased menstrual flow, which are commonly seen in women over the age of forty and are of considerable importance. Disappointingly, the risk of venous thrombosis with these drugs has been exaggerated by epidemiologists and the media community, and the actual incidence of venous thrombosis is very low and is significantly reduced compared to pregnancy. To avoid menopause-related symptoms, compounded oral contraceptives have been prescribed as a routine regimen off the instructions for many years, and in many countries, ongoing certification, longer consecutive cycles and flexible regimens are available. The effectiveness of contraception is increased by maximizing the suppression of internal circulation and reducing or avoiding hormone-free intervals. Tolerability is further enhanced by reducing symptoms after hormone withdrawal and by reducing pain and heaviness. Recent studies on androgen combination tablets to improve sexual function should be specifically targeted at perimenopausal women who are at high risk for low libido. After the age of forty, women’s doctors usually prescribe progestogen-only pills (POP) to minimize the risk of VTE. The disadvantage of low-dose POP is that it needs to be given closely to work during only a 3-hour window each day. The two main benefits of high-dose deprenyl POPs over low-dose POPs are reliable ovulation suppression in more than 99% of cycles and a 12-hour window. Although ovulation is suppressed, endogenous estrogen levels are maintained in the physiological range. However, the main drawback of high-dose POPs compared to any other POP is the high incidence of breakthrough bleeding, which is a significant problem in the perimenopausal period. No benefit has been found from POPs for menopause-related symptoms, and they may induce persistent premenstrual syndrome (PMS)-type progestational side effects. For contraception in women over the age of forty, the levonorgestrel intrauterine device (IUS) system is an excellent option. It not only provides reliable contraception, but also relieves heaviness and acts as a progestin component of HRT. However, early irregular bleeding and systemic PMS-type side effects can occur with its use. Recently, a low, small release of 12 mcg (every 24 hours) of levonorgestrel (instead of 20 mcg) has been found to be significantly better for perimenopausal women, it is more easily adapted and reduces systemic progestin side effects. However, it is not effective for menopause and is not licensed as a progestin component in HRT. 10 mcg of IUS (levonorgestrel system for menopause) has been shown to have good endometrial protection in HRT studies. A point of shame is the missed opportunity to extend 12 micrograms in HRT, thereby enhancing the benefit for perimenopausal women who are intolerant to progestins and require estrogen therapy. Stored progestins are not currently recommended for women over the age of fifty because the extended low estrogen status will increase the risk of osteoporosis. However, the preparation of “add-back” estrogen may improve the prospects for contraceptive methods and HRT use in perimenopausal women. The implantable etogestrel bar provides good contraception; however, it has the disadvantage of causing more than 50% of irregular vaginal bleeding compared to POP. When using this method, fluctuations in perimenopausal hormone levels make irregular bleeding more likely in these women; it has the advantage that although ovulation is suppressed, estradiol levels are not, so there is no additional risk of osteoporosis. Conclusion The contraceptive pill is used in perimenopausal women not only to prevent pregnancy but also to improve quality of life and achieve primary prevention. This is particularly important for perimenopausal women because changes in endogenous hormone levels often cause a decline in the quality of a woman’s life and sexual function. Technical advances in the content and methods of newer hormonal contraceptives have the potential to achieve this goal, and it must be more targeted to meet the specific needs of this age group. The continued development of new programs (containing selective estrogens, progesterone receptor modulators) can further enhance benefits and reduce risks. This is done through appropriate resource allocation, education, and maximizing health benefits to prevent unintended pregnancies and thus optimize menopause.