Combined oral contraceptives (COCs) are still the most common method of contraception due to their convenience of use and favorable safety profile. It should be remembered that patients of advanced reproductive age constitute a special group for contraceptive counseling, since not only high contraceptive efficacy but also a number of other extra-contraceptive benefits are of extreme relevance in them. At the same time, it should be noted that COCs are not a treatment method for any diseases (their direct purpose is reliable contraception!), and their extra-contraceptive benefits are only an addition to prevention. In 2022, an innovative COC based on a unique estrogen – estetrol combined with drospirenone – was registered in the Russian Federation. This combination has a number of prospects, which are discussed in this article. © 2025 Elsevier B.V., All rights reserved.