If inability to sleep was your patients biggest perimenopausal symptom would you recommend both estrogen/progesterone or just one, if so, which one?

Not enough info: I would like to know more about your cycles and get hormone levels, as deficient estrogen and Progesterone can cause sleep disturbance. But, going with the averages, most wmen lose Progesterone first in perimenopause, then estrogen. Progesterone does often help with sleep (don't use medroxyprogesterone), so it would be ok to try it. There's a ~10% chance it will be stimulating rather than sedatin.