I understand that hormone treatment is out of the question and as long as that is true it should also be true for natural remedies that have some form of estrogen in their mix.
Your symptoms may not all come from the hormone change, especially the panic disorder. It may come from what being menopausal means to you at this stage of your life. I would suggest that you do see a therapist to work that out and any other contributing life problems that might be adding to your stress. It's good to have a successful career but sometimes you are so focused on that that you've ignored other existential issues that have to be addressed at this time of life.
My own opinion, and I'm not the doc, is that hormonal problems are best treated by natural medicine. We've all seen what allopathic medicine has done to women over the years. You're not sick, you have a hormonal imbalance that is quite natural, and there are quite natural ways to try to deal with it that are far less intense on the body than what doctors will do. And using an antidepressant to treat a hormonal problem is like treating a prostate problem with anti-histamines. Might hit some of the symptoms, but won't address the real problem. Try a naturopath and see if it helps any.
Actually, you can balance hormones without using synthetic estrogen. Most women have a problem with progesterone, not estrogen, which is why the synthetic hormone treatments have done so much harm. A naturopath can direct you in what does what if that's a direction you want to go in.
I had a similar peri-menopausal experience as you, but not quite as drastic on the anxiety end. Lexapro made a new woman out of me and I have no problem taking it forever if I have to. Apparently I was lucky that I responded to it immediately without the weeks-long wait most people experience with anti-depressants. I know I needed ADs since puberty and I kick myself for waiting until I was 40 to talk to my doctor.
Believe it or not, black cohosh (herbal remedy) helped a great deal with the hot flashes and night sweats. Since they would come in waves - like a month on and a couple months off - I only took it when I needed it, and at a quarter of the recommended dosage on the bottle. It seemed like overkill to go on hormone therapy for something so erratic, so I'm really glad the cohosh worked out.
I wanted to give an update! I recently found a therapist who I have enjoyed working with enormously. She sent me to a psychiatrist to help with some meds. He increased the dose of effexor, and put me on klonipen (.25) at night to help me sleep. He also gave me xanax as needed.(.25) I have been on the meds for a little over two weeks and the panic attacks have subsided. I only needed the xanax twice and I'm not really sure it did much for the attack. My only concern is how sleepy I am most of the time. I am so grateful to get some rest at night that I am hoping the sleepiness during the day will subside. I will continue to work with my therapist as I KNOW that is a big help to me at the moment. If I had known how good it would be to talk to someone like her I would have done it years ago!
Thanks to all for your input.