Because of the diversity of medical and social circumstances of women over 40, there are no general rules regarding contraceptive choices for them. Gynecological or general pathological conditions should be considered in selecting a method, as should harmful health habits such as alcoholism and smoking, and the habitual use of medications. Hormonal contraceptives are very effective and practical, and give indirect benefits such as regularization of the cycle and amelioration of brease disorder and dysmenorrhea, but they increase cardiovascular risks. The risk of death from myocardial infarct is multiplied by a factor of 34 for women over 40 who smoke. Pill use is associated with a modification of the serum lipids and a tendency to hypercoagulability and increased risk of thrombosis, as well as a deterioration of glucose tolerance and an increase of insulin secretion. The estrogen and progestin combined oral contraceptives (OCs) have opposing effects on lipid metabolism; the overall effect depends on the dosage, the compounds used, and the hormonal profile of the pill. Combined OCs cause an elevation of blood pressure that may appear immediately or progressively over time. Synthetic estrogens increase activity of the renin-angiotensin system, resulting in increased aldosterone levels, reduction of renal blood flow, and sodium retention. Smoking considerably increases vascular risk and is a contraindication to pill use after 35 years. In the absense of further study, it appears that OCs do not in general increase the risk of breast, endometrial, cervical, or ovarian cancer, and in some cases they reduce risk. Some physicians refuse to prescribe OCs to any patient over 40, but many others take a more flexible attitude. Absolute contraindications of OC use must be respected, and relative contrainidications suck as smoking, prediabetic status, and migraines become absolute for women over 40. Biphasic minipills may be the best choice because they combine effectiveness, small dose, and an equilibrated hormonal climate. Women over 40 who are multiparous, who desire no more children, who have no genital anomalies, and who have a stable conjugal life may be ideal candidates for IUDs. IUDs are effective and avoid many shortcomings of OCs. Their complications of perforation, ectopic pregnancy, and infection are infrequent and their possible impact on fecundity is less important in this group. Bleeding and pain are the main disadvantages, but pregesterone-releasing IUDs may reduce the volume of bleeding, combat endometrial hyperplasia and alleviate menstrual pain. Vaginal methods offer safe contraception to women for who other methods are contraindicated. Their effectivenes is less than that of pills or IUDs but still sufficient. Although sterilization is not legal in France except for some precise therapeutic in dications, it is a logical choice for premenopausal women in good health who have the desired number of children and a stable emotional life.