Endometriosis: Expert Surgical and Integrative Approaches
Highly individualized, expert surgical and integrative endometriosis care is grounded in the science of how endometriosis develops, so it can be detected early, treated gently, and kept from returning, when possible.
Dr. Stepanian often begins her lectures on endometriosis and adenomyosis with the image of King Arthur's round table, where the knights depend on each other and support each other: every element of tissue both influences and is influenced by the others, at the cellular and molecular level, up- and down-regulating the genetic expression that drives disease and sustains it over time.
Understanding these mechanisms — and developing a true sense of the tissue involved — is what allows for early detection of endometriosis, prediction of how it may progress, timely intervention, precise excisional surgery when needed, and, crucially, reduction of the chance of recurrence.
Each element of tissue is influenced by, and influences, every other — so we treat the whole system, not only the lesions.
Real-time imaging at your visit. Dr. Stepanian conducts ultrasound in the office at the time of your appointment, allowing for an effective, immediate, informed discussion based on real-time, high-quality imaging.
Resolving disease with the body's own resources
In some cases, this attention to detail — and a foundation in embryology, genetic and epigenetic influences, and the mechanisms of cell damage and protection — reduces the need for surgery altogether. For patients who respond, non-surgical techniques can help resolve and control the disease, helping to enhance the body's natural defense mechanisms, and to establish effective and collaborative reproductive planning, while reducing the chance of recurrence.
We apply both hormonal and non-hormonal strategies that minimize recurrence, and we follow our patients well into their postmenopausal years, when recurrence is rare.
When Surgery Is Needed
Precise, tissue-protective excision
For patients who require surgery, excisional surgery is very important. Our surgeries have long used precise energy sources — including the contact Nd:YAG laser, which works exactly with the tissue it touches, and the CO2 laser, whose range of beam characteristics and power settings respond to the needs of the treated tissue with high precision in various tissue types and surgical scenarios.
When deciding on excision, it is essential to be gentle: not to enter planes of dissection that do not need to be entered, carefully selecting the extent of excision. Increasingly, where applicable, we move toward intratissue planes to treat endometriosis while protecting healthy surrounding tissue.
Protecting your ovaries and fertility
For ovarian endometriotic cysts (endometriomas), our ovarian surgery applies all currently known techniques to minimize tissue damage. We select the approach based on the quality of the surrounding ovarian tissue, close attention to its circulation, preoperative assessment of the ovarian reserve, multiple factors influencing ovarian response, and individualized expectations of each patient's tissue recovery response.
We work very closely with reproductive endocrinology and infertility groups to protect and maximize ovarian reserve, and to strategize care that supports each patient's reproductive potential. We also analyze additional factors leading to ovarian reserve reduction.
Progression of endometriosis to cancer is rare. Out of all locations of endometriosis, ovarian endometriomas are most associated with development of cancers, albeit very rarely. This is one of the reasons careful, individualized evaluation matters so much.
Expertise & Team
A team that teaches the field
Dr. Stepanian is fellowship-trained and lectures internationally on the development of endometriosis, drawing on deep clinical experience and international collaboration in selecting the best surgical and non-surgical strategies for each patient. With over 26,000 surgeries in endometriosis, her affiliated department of Prof. Leila Adamyan conducts world-class research, a pioneering group that has been formative in the establishment of an embryologic theory of the presence of endometriotic implants, the mechanisms influencing the development of endometriosis, explaining the causality of the presence of endometriosis lesions and predicting their behavior in response to surgery or other integrative techniques.
Our surgical team is exceptional. We have worked at the same hospital for 20 years, with the same core team for more than a decade.
Explore our minimally invasive surgery → · See lectures & press →
Symptoms & conditions associated with endometriosis
- Painful periods
- Chronic pelvic pain
- Pain with intercourse
- Ovarian endometriomas
- Adenomyosis
- Reduced fertility
- Pelvic adhesions
- Heavy or irregular bleeding
- Uterine/Müllerian anomalies
Please note Academia accepts various insurance plans and communicates directly with referring physicians.
Talk with Dr. Stepanian about your endometriosis
We'll review your history with real-time in-office ultrasound and build an individualized plan — surgical or non-surgical — designed to protect your health, your fertility, and your future.