Anxiety- from menopause? Or from hrt? Help!!!

Hello,
I had my total hyst about 9 monts ago due to stage 1 uterine cancer. I'm 38 so it was quite a shock. I had port partum anxiety with my 2nd baby and went on Zoloft for a year. It helped a lot.
With my cancer diagnosis I was of course very very anxious and have been since my surgery. I went on vivelle 0.375 a few wks post op. I went back on Zoloft at about 4 months post op and it was a nightmare- made me feel a lot worse (and yea I gave it enough time to work) so went off thr and upped my hrt to 0.5 and that helped after a few wks.
Now here I am again, so so anxious and having random panic attacks. I've been in therapy and she thinks I need to try another med. I'm jut not sure- how to you know if it's hormonal? If its from the hrt? Or if it's true anxiety that I need an anti depressant for? I gained a boat load of weight on Zoloft so I'm afraid of that too (then again I'm afraid of everything these days!!!!!!) my dr wants Me to try lexapro next.......

Thoughts!? How do you know? I see my gyn a week from Tuesday so I will ask her of course. In the meantime I have Xanax to get me through but would love any thoughts on what to ask for. I love my gyn so I know she will be helpful and receptive to what I have to say.....

I would absolutely ask them to test your estradiol level. If they tell you that it's not necessary...INSIST! You're really young and it's highly likely that the lower dose of the patch isn't enough to fill your needs. There is also a possibility that the patch may not absorb as it should. The only way to tell is by checking a level. It's also good to get a copy of your results. Sometimes a level that a Dr. says is normal may mean that your levels are rock bottom and normal for a postmenopausal woman. The idea with replacement is to pull you up out of the postmenopausal level. My anxiety is off the charts when my estrogen level is too low.

The other assumption is that if you don't do well on the method or dose you're using that it's not estrogen related. There are many forms and many doses of estrogen replacement to try. That's because we're not all clones with the same needs.

It could be you aren't getting enough estrogen still. I started right off on the .1 dosage and have very little if any anxiety now. That's saying something because I have generalized anxiety disorder. I'm 42 years old and wasn't in menopause at all. Maybe you could try the next dose up.

Thank you SO much for your replies. This is all so hard to navigate!!!! I meet with my gyn oncologist for a checkup Friday so will ask him how he feels about increasing my estrogen levels (since I had cancer). He usually defers to my regular gyn when it comes to menopause though! Maybe I will ask him to check my levels so that we have results for my reg appt next week.

I will add that I have no other menopause symptoms/ no hot flashes, joints ok, no headaches etc. I do have a low libido, but that's it. So I hesitate to increase estrogen but also hesitate to go on an a/d if not necessary either! Ugh!

For some of us, the lack of estrogen affects our serotonin functions considerably. For me, it takes very little estrogen to stop my hot flashes and a lot more to stop the other mental/emotional issues.

If you dr doesn't want to give you a higher dose, and you don't want to go back on pharmaceuticals, you could try adding in a non-estrogenic herbal remedy to help supplement.