Dogmama, the E-string is the same thing as the tablets, except you just insert a new one every 3 months. It's about 2mg of estrogen over that period. Very low dose. It's a ring that is just like the ones that are used for birth control.
As for the natural remedies, +1. I tried everything, and while my symptoms were mild, none of the natural remedies helped. So, I just lived with the flashes and got the help for the dryness.
Sherrylouz, early forties is not too young for perimenopause. I was around 42-43 when my periods started becoming irregular, heavy, and annoying. They stopped when I was 48, but for two years before that, I went 9-11 months without a period. So, while some people are having kids at age 42, I was definitely in perimenopause. My mom and aunt both were the same way.