Dearest:   My guest tonight is a board certified, OB/Gyn with a successful 
medical practice in New York City. Dr. Corio is also an attending physician at 
the Mount Sinai Medical Center in NYC, where she teaches medical students and 
residents.

Dr. Corio hosted a popular radio women's health talk show, and is the author of 
the bestselling new book, "The Change Before The Change: Everything You Need to 
Know to Stay Healthy in the Decade Before Menopause." 

Welcome to Power Surge, Dr. Corio. Menopause seems to be the "topic of the 
day." You can't turn on a radio or TV show, or open a woman's magazine where 
someone isn't talking about menopause.

With all we've learned about perimenopause over the past five to ten years, 
what are your thoughts about how successfully doctors are communicating to 
their perimenopausal patients? 


Dr. Laura Corio: Hi, everyone :) I can tell you that I'm very disheartened and 
upset about the medical community, that the doctors are not listening to women. 
I have many referrals to my practice from psychiatrists and other patients 
because I take care of perimenopause. Doctors have said to patients that 
because you're still menstruating you can't be in menopause, come back to me 
when you don't have your period anymore, there' s nothing I can do at this 
point. The women are going out of their minds and being told that they need 
antidepressants when what's going on with them is their major hormonal 
fluctuation and by the time the doctor gets to see them, their hormones have 
straightened out.

I'm not thrilled with what's going on in the medical community. I've been all 
over the country and I'm saddened to see how doctors are taking care of women. 
Women are desperate for information, they want the information, they will take 
charge and feel better if they get this information.


Dearest:   You mentioned antidepressants, Dr. Corio. What are your thoughts on 
the new theories of prescribing antidepressants for menopausal symptoms? 


Dr. Laura Corio: I prefer to check hormone levels in perimenopause. I like to 
go through a patients history and symptoms. If wanted and have tried the 
approaches and are not feeling better, to try natural hormones or low dose 
birth control before going on antidepressants.


Dearest:   Thank you, Dr. Corio. 


peggy: Any suggestions on how to have a decent night sleep....meaning not 
waking up at 2am and unable to go back to sleep


Dr. Laura Corio: Peggy, are you waking up because of hot flashes that are 
disturbing your sleep or do you have insomnia? 


peggy: I'm not having hot flashes. I just wake up and can't get back to sleep. 
I using natural progesterone (micronized) 


Dr. Laura Corio: How old are you?


peggy: 48


Dr. Laura Corio: Have you had a long history of sleep problems or is this 
something new?


peggy: Something new.


Dr. Laura Corio: For how long? 


peggy: Sometimes are worse than others. I went three months with no period, 
then last month had a heavy one. Seems related.


Dr. Laura Corio: How is the progesterone doing? Is it helping at all? How is 
the pattern related to your period?


peggy: Last couple nights I increased the progesterone and have slept better. 
Still wake up, but seem to get myself back to sleep


Dr. Laura Corio: How much progesterone?


peggy: 200mg twice daily (0ral)


Dr. Laura Corio: Continue to use that, email me at DrLauraCorio@hotmail.com for 
more info. 


Menobud: Dr., my stomach has been screwed up off and on since I started peri, 
and when I began HRT three months ago, it exacerbated the problem. I've went 
off of the HRT about four weeks ago and I'm still having problems. Will this 
straighten out when my hormones straighten out?


Dr. Laura Corio: Did you see a GI specialist and have a colonoscopy?


Menobud: I have an appointment next week. It feels like waves of heat. 


Dr. Laura Corio: Do you have the GI? What hormones are you on and what have you 
tried?


Menobud: I was on Cenestin and Prometrium


Dr. Laura Corio: Are you having hot flashes as well?


Menobud: I break out in a sweat, yes.


Dr. Laura Corio: Did you ever have compounded hormones? The patch? 


Menobud: I switched to the vivelle dot, but was only on it a short time.


Dr. Laura Corio: How about some black cohosh or soy?


Menobud: I used to do the soy, yes, but because of insomnia I tried the HRT.


Dr. Laura Corio: There may be something else going on. Try a complete GI 
workup.


Menobud: I will. But could it be the hormones?


Dr. Laura Corio: You clearly didn't feel better on the hormones. Do the workup 
to be sure that there's nothing else going on.


Menobud: Thanks.


Dr. Laura Corio: It may not be a menopause problem. You need a good internist.


Menobud: Thanks, Dr.


Dr. Laura Corio: If a patient doesn't improve with hormones, it's my belief 
that there may be something else going on. You need to look at this issue and 
see if there's another way to deal with it. 


Menobud: Thanks, Dr.


Dearest:   Meryl, I think what Dr. Corio is saying is not to assume that it's 
related to menopause, but to get yourself thoroughly checked by a GOOD 
internist to see what the problem might be. Am I right, Dr. Corio? 


Dr. Laura Corio: Yes


Menobud: Oh, I didn't assume it, was just wondering. 


NancyV: Do you use saliva testing? If so, do you agree that progesterone needs 
to be 200 times greater than estrogen? 


Dr. Laura Corio: I do use saliva testing. I find that saliva testing CAN be 
more accurate. It is the active form that is being used by the body. I do blood 
testing, too.

No, I don't think that progesterone needs to be 200 times greater than 
estrogen. I look at progesterone as a secondary hormone, in a relationship with 
testosterone and estrogen.


Dearest:   Just curious, NancyV, but where did you get that figure of 
progesterone needing to be 200x greater than estrogen? 


Dr. Laura Corio: I do use a lot of progesterone cream and natural, when women 
are having trouble.


NancyV: Dr. Lee's book; I also had a test with 7 estrogen and 1000 progesterone 
and I have found relief with the cream


Dr. Laura Corio: There are situations where a woman can have too much estrogen 
and not enough progesterone and progesterone would be given, cream or 
micronized, but there are also situations where women are having fluctuations 
in estrogen as well as progesterone.

I deal with perimenopausal patients every day and many do not do well on 
progesterone cream.


NancyV: Thank you 


Dearest:   For years we've been told that HRT protected us from heart disease. 
Don't the preliminary results of the Women's Health Initiative regarding synthetic 
HRT and heart disease negate all the old theories? 


Dr. Laura Corio: I think that women are very confused about estrogen and heart 
protection. The drug Prempro, or Premarin/provera, which has been prescribed 
for many years has never been studied on heart patients. If we look at estrogen 
alone, estradiol (E2) has been studied and shown to be beneficial to the heart 
but when Provera which is a synthetic progestin was added to the protocol, it 
negated all the benefits of estrogen on the heart. 

On the contrary, all micronized progesterone or natural progesterone attenuates 
the benefit of estrogen on the heart. If a woman takes HRT with bio identical 
hormones in the perimenopausal period, the studies have shown that she will 
reduce her rate of heart disease.


Dearest:   Thank you. 


karen: I think I am past peri menopause - I haven't had periods in over a year. 
I am now taking femhrt. Does this have any effect on heart disease?


Dr. Laura Corio: Well, that's a good question because that product per se has a 
synthetic progestin which has not been studied. I would ask your doctor about 
bio identical hormones such as progesterone (naturally compounded)


karen: I have taken other hrts but had horrible side effects. This is the only 
one that seems to work on me.


Dr. Laura Corio: Have you ever taken natural progesterone?


karen: no, I havent. By the way, I am 44 yrs old


Dr. Laura Corio: Possibly you could get compounded hormones or Estrace.


karen: I tried Estrace and Provera on a cycle basis and that really put me into 
a funk


Dr. Laura Corio: Try Estrace and all-micronized progesterone. Email me at 
DrLauraCorio@hotmail.com. It's the Provera that I don't like.


karen: Thanks Dr Corio!!


carol I am 44 and in the beginning phases of perimenopause. During a physical, 
I had high blood pressure for the first time. Is this a common symptom?


Dr. Laura Corio: Are you overweight or did you gain wait?


carol I'm 20 lbs overweight but work out regularly.



Dr. Laura Corio: The increase in weight can raise blood pressure and you see 
this with perimenopause. With perimenopause the blood pressure can go up with 
the weight gain.. this is called Syndrome X.

If you want to know more about this, feel free to email me at 
DrLauraCorio@hotmail.com and PLEASE get my book, The Change Before The Change. 
You will find the answers to all your questions.


venusrose9: Do you think 1.25 of Premarin is too much to be taking, it is what 
was prescribed when i started with night sweats on .625?


Dr. Laura Corio: 1.25 is too high. Check your testosterone levels. You can 
probably decrease the estrogen and add micronized testosterone and reduce your 
hot flashes.


venusrose9: What should i say to my dr.?


Dr. Laura Corio: Go back to your doctor and ask for a testosterone and free 
testosterone on your blood. If those levels are very low, you can get more 
relief and less risk for breast cancer with the testosterone and estrogen. 


Dearest:   What do you say to the patient who asks you, "Will I ever be my old 
self again?"


Dr. Laura Corio: Absolutely!!! I have patients who come all over the world and 
the country. They fly in because they know I treat menopause. They thank me 
because they know that there is a way to feel better, whether it's through 
alternatives such as vitamins, herbs, phytoestrogens, minerals or low dose 
natural hormones or standard hormones. I find the level that my patients need 
to be at and I titrate it through the period of time until they are perfect and 
feel fine and they thank me.

Women can feel perfect. There are times when they will be given a certain 
protocol and the will feel fine for 6 months then they aren't feeling so well, 
so they come in and we'll change the protocol until they feel good again.


Ute: Hi Dr. Corio. What do you feel is the best treatment for perimenopause? Do 
you base you decision mainly on hormone levels or do you treat the symtoms? 
Once on HRT how long do we have to stay on it?G


Dr. Laura Corio: The first thing that I always try is alternative approach 
meaning vitamins, minerals, herbs, phytoestrogens. I go by symptoms not blood 
tests. If a patient does not feel better on alternatives, I start with low dose 
bio identical hormones. I like to start patients on low dosages because they 
don't have symptoms from the hormones. Studies have shown that women on 
standard hormones will stop within 3 months because of terrible symptoms such 
as breast soreness, bleeding, weight gain. If you start a patient on low-dose 
hormones, they will stay on them, they will get the benefits, their symptoms 
will improve. If the symptoms are not controlled, they are more willing to go 
up slowly because they feel ok.


Ute: How do we know when it's over if we are on HRT?


Dr. Laura Corio: How long? Nothing is written in stone. It has to be 
reevaluated by the doctor as the person ages. Menopause is defined by not 
having a period for more than a year. When you're on hormones and you stop 
getting a period, you can pretty much say that it's post-menopausal. If it's 
sequential pills, you may not be able to tell when you're postmenopausal.


Ute: Thank you!


Dearest:   Dr. Corio, thanks so much for visiting with us in Power Surge tonight. 
What a stimulating and informative chat. You're a barrel of knowledge and 
enthusiasm :) I highly recommend, "The Change Before The Change". It's an easy 
read with lots of vital information for perimenopausal women. If you have any 
additional questions, feel free to write to Dr. Corio at 
DrLauraCorio@hotmail.com.


Dr. Laura Corio: You're welcome :)




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