If prometrium (micronized progesterone) alone isn't bringing relief of perimenopausal symptoms would adding estrogen help? which is better, a cream or a pill?

Yes estrogen helps: Prometrium (micronized progesterone) is primarily used in the perimenopause to protect the lining of the uterus from estrogen when women are taking estrogen for menopausal symptoms. Estrogen has definitely been shown to help with hot flashes, night sweats, insomnia, vaginal dryness, etc. Personally, i like the patch the best. Talk with your doctor about the benefits and risks, good luck!