Some women get irregular periods without any other symptoms. Unfortunately, there is no test for perimenopause. Measurements of hormone levels do not often give us a lot of information. Estrogen Replacement Perimenopause is a fluctuating state of affairs. Once the ovaries start slowing down, estrogen production does not constantly decline.
Most women bleed about two ounces during regular periods.
Signs of an abnormal perimenopause include intensely heaving bleeding for long periods of time or having a short time between heavy bleeds. In that scenario, I recommend stopping estrogen replacement, at least temporarily, until her ovaries quiet down again. The most popular therapy to emerge over the last 10 years is the use of very low-dose birth control pills to control symptoms. They shut down the fluctuating ovaries and provide fixed levels of estrogen and progesterone on a daily basis. We used to think that women over age 40 on the pill had an increased risk of cardiovascular disease, but now we know that only smokers on the pill are at risk.