Reproduction continues in the perimenopause. To prevent unintended pregnancies, the use of a highly effective reversible contraceptive is necessary. The most effective methods of contraception are hormonal contraceptive methods and the intrauterine device (IUD). Barrier contraceptives can have a high-use effective rate in motivated users, too. Hormonal contraception has both risks and benefits, but can be used safely for healthy women without risk factors during the time of perimenopause. To prevent the metabolic side effects of synthetic estrogen-ethinyl-estradiol in the contraceptive pill in perimenopause, the use of natural estrogen (estradiol) in combination with a progestagen for contraception is effective, too. A major problem of IUDs has been the increased incidence of bleeding or dysmenorrhea. For these women, Progestin-releasing IUDs are recommended because of their ability to reduce the amount of uterine bleeding associated with menstruation.