Hi Jo24
from me too.
Yes it is all very well in theory to have a steady trickle of both hormones - it does prevent the high and lows associated with cyclical HRT but as Mary G says it is often the continuous progestogen that causes problems - low grade pms type feelings, and the anxiety you describe, especially as the progestogen is synthetic.
As you are well post-menopause, depending on how you feel about the Mirena coil, another alternative is to try for a longer cycle which is what I do. OK I don't like taking the progesterone but I keep it to a minimum by only taking it on a 6-8 week cycle (and having it vaginally). It may not be that you need a higher dose of oestrogen - just that you need to be on oestrogen only for a longer time before the progesterone is added. I started HRT at just under 54 when I was in late peri-menopause and had a 50 mcg patch. This was almost 11 years ago now and have been on more or less this dose ever since. Long cycles require medical supervision to monitor the womb lining.
You won't know whether your symptoms are due to insufficient oestrogen or the continuous oestrogen unless you try one of these regimes ie Mirena + oestrogen (patch or gel), or oestrogen ( patch or gel) + separate progesterone.
In your position I would try not to change too many things at once ie keep to the patch at first with separate prog or Mirena, and if necessary increase the oestrogen dose - and if after a few months you don't feel any better then perhaps think of changing to the gel? I should add that there is still some systemic absorption of oestrogen from the Mirena even though most of it is absroibed locally and keeps the uterus lining thin.
All the different types of HRT are listed under Treatments ( above tabs).
At this point I would concentrate on getting your HRT right and not think about medicating anxiety - this is often not necessary and not advised (by NICE re menopausal symptoms), except for extreme cases or for women who may have had life-long anxiety or very traumatic stressful life events. There are various strategies available eg nomorepanic website and a blog on this website about CBT (DIY!) and self-help measures:
https://www.menopausematters.co.uk/daisyblog.phpHope this helps - and do get in touch if you need any more advice
Hurdity x