The need for contraception in a period of life characterized by irregular menstrual cycles as the perimenopause represents a social and biological event for each woman and a challenge for the gynecologist. The use of oral contraceptives in perimenopause has been vastly discussed in the last decade. Several investigators have focused their attention on the risks related to hormonal administration to older women neglecting all the advantages. The introduction of new lower-dose formulations and progestin-only preparations as implants or intra-uterine system has deeply changed the indications for hormonal contraception allowing their use in patients in whom it was previously contraindicated. Cumulative evidence has demonstrated that the use of hormonal contraception during the perimenopausal period does not offer only advantages in term of cycle control but also gives an important protection against the development of gynecological malignancies. However, in clinical practice the use of hormonal contraceptives in older women has not been accepted by a large number of physicians who continue to consider hormonal contraception in women over forties a tabù. The aim of this review is to discuss lights and shadows of the use of hormonal contraception in perimenopause.