What is best approach to perimenopause? natural or estrogen?

Depends upon you!: By natural, i assume you mean not taking anything at all. This is fine as long as you can tolerate the symptoms & changes associated w/perimenopause. However, if you need something, then estrogen is the gold standard, far & above any other option. But it's not w/o risk. Talk to your doc. Ask about different forms as risk varies there, too. There's also bio-identical vs non-bio-identical.