The aim of this study was to compare metabolic changes during use of low-dose combined oral contraceptives (COCs) and those of nonhormonal contraceptives in perimenopausal women. Thirty-nine healthy women over 40 years old who attended the Family Planning Clinic of the King Chulalongkorn Memorial Hospital, Bangkok, Thailand, were recruited, 20 in the COC group received COC preparations containing 30 Ag of ethinyl estradiol and 150 Ag of levonorgestrel and 19 in the nonhormonal group were intrauterine device users. Blood samples were taken upon admission and 6 months later. Minor biochemical changes associated with low-dose COC use included an increase in glucose tolerance, triglycerides, serum albumin, serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) levels but a decrease in fasting plasma glucose, total cholesterol, high-density lipoprotein cholesterol, total bilirubin and alkaline phosphatase levels. There was no clinical significance for the metabolic changes. Low-dose COCs can be a satisfactory contraceptive choice for healthy perimenopausal women.