Midlife contraception is often ignored in clinical practice, yet it is crucial for women facing the challenges of perimenopause and early postmenopause. This chapter looks at the changing contraceptive needs of women aged 40 and older, highlighting the dual goals of preventing unintended pregnancies and improving long-term health. Fertility may decrease, but ovulation can continue unpredictably, making contraception important until menopause is confirmed. The chapter reviews hormonal and nonhormonal options, such as combined hormonal contraceptives, progestin-only methods, intrauterine devices, and permanent solutions, with a focus on cardiovascular risk, cancer prevention, and bone health. It also highlights the noncontraceptive benefits of certain methods, including menstrual regulation, management of hot flashes, and prevention of endometrial hyperplasia. Clinical decision-making depends on individual risk assessment, existing health conditions, and patient preferences. The chapter discusses counseling strategies, transitioning off contraception, and the role of contraception in general midlife care, including STI prevention and sexual health. By combining evidence-based guidance with practical guidance, this chapter helps clinicians provide informed and suitable contraceptive care for midlife women.