Academia Gynecologic Office Visits

Early Detection, Preventive, and Minimally Invasive Care for Women

Dr. Assia Stepanian is one of Atlanta’s most trusted gynecologists. She is recognized for her expertise in multiple fields of Gynecology. Please see our service page for full list of services provided by Academia.

Founded by Dr. Stepanian, Academia of Women’s Health and Endoscopic Surgery is devoted to early detection of gynecologic pathology and to the treatment of pathology, using the most minimally invasive medical and surgical routes. All gynecologic conditions, other than malignancy, are treated at Academia with a high degree of individualized care. The holistic health of the patient is of primary concern to the practice.

Dr. Stepanian personally participated in the development of the Standards of Gynecologic Care and undertakes ongoing research, authoring publications consulted by doctors around the world. She participates in many international colloquia. Dr. Stepanian enjoys working alongside and mentoring the young generation of physicians. She enjoys collaborating with them and analyzing new frontiers in diagnostics, as well as the treatment of various gynecologic conditions. She has served on multiple advisory boards and travels and teaches extensively.

When annual gynecologic visits are conducted by a gynecologist who is thorough and highly experienced in managing gynecologic conditions in women of various ages, a significantly higher number of problems are prevented or, at least, detected early.

Most of our patients enjoy an opportunity to discuss problems identified at the time of their annual check-up. We believe in giving our patients as much information as possible, while making them central to decision making in all aspects of their gynecologic health. Having an opportunity to discuss and manage medical conditions found on the day of the annual examination, as opposed to having a separate appointment, decreases the wait time that our patients may experience otherwise – thus, decreasing stress.

Please let us know, however, if you would like for us to focus only on the annual visit and to schedule a problem visit at a separate time.

Let Us Look at the Special Elements/Advantages of Academia’s Programs in Gynecologic Malignancy Prevention and Early Detection of Gynecologic Pathology, as Well as Gynecologic Holistic Health

Transvaginal Ultrasound (TV U/S) at the time of annual examination for prevention and early detection of uterine and ovarian cancers

flower_office_visit_one_petal Transvaginal ultrasound conducted at the time of our Annual Plus examination is based on the experience and data that demonstrate the effectiveness of this procedure in the early identification of cancer or premalignant conditions of the ovaries and the uterus, even in asymptomatic patients.

It is important to remember that while much diagnostic information is received when conducting gynecologic examinations, doctors are not likely to feel endometrial polyps and most often are not able to feel ovarian cysts the size of the normal ovary. in addition if there is a small amount of fluid in the pelvis, this too may be undetectable without an ultrasound. Yet all these issues may require further investigation.

While Transvaginal Ultrasound is not a general standard requirement, thanks to our approach, in a single year we identified over 150 patients with asymptomatic endometrial polyps and removed them hysteroscopically at later visits in the office. In general, endometrial polyps have the ability to become malignant in 5% of premenopausal women and 11% of postmenopausal women if left untreated. We have identified women with premalignant ovarian masses/cysts who required no therapy other than surgery and women with stage I ovarian malignancy, who after the staging procedure, were only treated with several cycles of chemotherapy.

Furthermore, TV U/S allows for detection of masses in the bladder even before symptoms are apparent to the patient.

Transvaginal Ultrasound (TV U/S) at the time of annual examination for early detection of gynecologic ovarian and uterine pathology in women desiring reproduction

flower_office_visit_full_petal Many gynecologic conditions, like uterine myoma/fibroids, ovarian cysts, and adenomyosis, can remain asymptomatic in women of reproductive age, yet they may pose problems with fertility or the ability to carry pregnancy to term.

When a small myoma is found that does not interfere with the endometrial (uterine) cavity, treatment is not always needed. Finding it early allows women to consider commencing childbearing earlier rather than later. This is important because should a myoma grow significantly or should it be localized inside of the uterine cavity, heavy bleeding, anemia, and pregnancy-related complications may occur.

If reproduction is not desired at the time of the detection of uterine fibroids, we may utilize therapy to slow down the progression of fibroids and strategize therapy to control symptoms. In addition, we may postpone a myomectomy until a time that is closer to planned reproduction. Submucosal (or intracavitary) myoma is easily treated hysteroscopically without any incisions.

Ovarian cysts can have a varied etiology. Depending on the type of ovarian cysts, associated symptoms, family history, malignancy markers used (when applicable), and evaluation of the ovarian reserve, there are several strategies for the management of the condition. Most importantly, earlier detection allows for better outcomes, with preservation of the ovarian reserve and reproduction. This is of special importance in patients with edometriosis.

Some ovarian cysts may be of the size of the ovary and produce no symptoms, yet the structure of the cysts may suggest the presence of more advanced ovarian pathology. The earlier such pathology is diagnosed and treated, the more ovarian tissue/reserve is preserved.

Dr. Stepanian and the transvaginal ultrasound saved my life. Literally. My previous gynecologist had moved a couple of years earlier, and I simply had not taken the time to find someone else. With no problems other than the occasional emotional meltdown and sweaty pajamas—bi-products of being 41, I might have put the visit off even longer had not a dear friend insisted I see this doctor. I had planned to make a quick trip from the school where I was teaching and get back before the end of the day. But this doctor was more thorough than that. She sat down with me in her office, since this was my first visit, and we talked. By the time my feet were in the stirrups, I was no longer a stranger. But this was not the only thing Dr. Stepanian did that was different from what I had experienced in the past. She is the only doctor I had ever seen who included in her exam a transvaginal ultrasound. She thoroughly explained how it would feel and what its purpose was before she began this very simple—but, in my case, lifesaving study. I married late in life and never had children, so when she said something was there in my ovary, I was glib and said, “It’s not a baby, is it?” She didn’t laugh. She was already thinking ahead. “Would you want it to be?” she asked, not taking her eyes off the monitor. I said I guess not and laughed the way one does when it’s still a possibility even though not a good idea. Then I really started to notice how intent she was on one section of the image, returning again and again to that one ovary. She explained that she did not like the way something looked and she thought it should come out immediately. She spent a good deal of time with me that morning (and I shall forever after be patient in a doctor’s office, for you never know what someone else is dealing with in the next room). Later that night, after hours, she called me to make sure I understood the plan and to see if I was all right. Within a matter of days, I was at Northside Hospital in Atlanta for a laparoscopic surgery in which Dr. Stepanian removed the mass without disrupting it. Subsequently, I was diagnosed with Stage 1A ovarian cancer, a rare diagnosis since most ovarian cancers are not found until much later. Too much later. Ovarian cancer will be diagnosed in approximately 22,000 women this year. Approximately 14,000 are expected to die from it. The survival rate for those whose cancer is found in Stage IA is around 94 percent. I’m one of those survivors, thanks to Dr. Stepanian and the transvaginal ultrasound.

Age-Related Holistic Discussion in Women’s Health

A special aspect of our Annual Plus Preventive Visits is the inclusion of an age-related discussion covering physiologic, hormonal, social, and psychological aspects of a woman’s age and stage of life, from adolescence to the “golden years.” Aging is a process that is ongoing in each of our lives. Identification of every woman’s gynecologic health tendencies—combined with attention to her medical problems, history, family history, genetic predisposition, and correlated to her age and life goals—enables well-rounded and individualized discussions.

Adolescent Years/First Gynecologic Visits

adolescent_office_visitDr. Stepanian’s caring, gentle, and relatable personality immediately puts young women at ease. So many developments are new to young women, and so much is unknown to them about what is normal and not normal in relation to their bodies, decisions, relationships, and moods. Because of the priority we place in establishing trust between doctor and patient, younger patients benefit greatly from open discussion and advice.

Additionally, several gynecological conditions can be detected in adolescent years. Among them are Polycystic Ovarian Syndrome, menstrual irregularities of various causes, blood disorders that lead to heavy menstruation, endometriosis, myoma, and various malformations. See MRKH. Furthermore, this is a very important time when women are making decisions about intimacy. At Academia, we gently guide these young women while helping them to make the right decisions for themselves, and for staying safe and engaged in their lives.

Childbearing/Reproductive Years

childbearing_office_visitThese years are characterized by many milestones in self-development, in relationships, and in career choices. Many gynecologic conditions start in this age group and require proper attention. Still, one of the most important questions asked is whether or not pregnancy is desired; if it is, we must determine what needs to be done for the pregnancy to be as healthy as it possible for each individual woman. These questions are essential, and proper attention to them affects the entire life of a woman.

In accordance with the recommendations of ACOG (American Congress of OBGYN), and based on much published evidence and on our own experience, the most important advice we can give to women who desire pregnancy is to consider it earlier rather than later, starting from the 20s and to very early 30s. The older we get, the greater the chances for various gynecologic or other medical conditions. As one colleague said, “There is nothing easier than healthy pregnancy and nothing more complex than a complex one.”

If a woman prefers pregnancy later in life, we discuss associated risks and see what can be done to minimize them. Special attention is given to evaluation of the ovarian reserve and to early identification and management of medical conditions capable of complicating pregnancy or affecting long-term woman’s health. All gynecologic conditions other than malignancy are treated at Academia using minimally invasive medical or surgical approaches, and are studied by Dr. Stepanian extensively. Our patients take special comfort in this. We have a large network of expert specialists to whom we can refer our patients, if necessary, for evaluation of other medical concerns.

Should women not desire pregnancy at all, we would consider suitable long-term contraception for them. Among other conditions, we will watch for gynecologic conditions that often occur in women who have not experienced pregnancy.

Additionally, this age provides the perfect opportunity to cultivate healthy habits that help to minimize future gynecologic risks.

A Woman’s Journey to Menopause/Menopause

menopause_office_visitWhat an interesting and transitional time! Women question if they have done well in life; they are concerned about the wellbeing of their children, their parents, their husbands, and other loved ones. Often, they discover that they need to focus more on themselves!

Starting in the early 40s, we look for symptoms of perimenopause. Gradually sleeps worsens, hot flashes appear, changes in mood and concentration may become noticed, vaginal dryness and discomfort with intimacy may start occurring, and fatigue may set in. Our job is to identify and address these symptoms before a woman’s quality of life is significantly affected.

If hormone replacement therapy (HRT) or transitional hormonal contraception is indicated, we take into account the patient’s medical history, family history, and lifestyle. We evaluate for concurrent and concomitant conditions, as well as evaluate and test factors that may influence thromboembolism, liver health, and the presence or risk of malignancy. Our approach, while requiring a very thorough initial evaluation, does not involve repeated lab work and levels adjustments.

In patients with breast cancer, liver disorders, thromboembolism, or patients who do not desire hormonal supplementation, we offer non-hormonal management of menopausal symptoms and/or osteopenia. We have successfully utilized MonaLisa Touch technology for treatment of vaginal atrophy and lichen sclerosis. See MonaLisa Touch®. We are highly selective, experienced, and successful in the use of the MonaLisa Touch technology and have seen many patients for whom intercourse has again become possible and desired.

Golden years/Anti-Aging and Active Aging from Menopause to Over 100

golden_years_office_visitThere are many beautiful and mature changes during these years. A new life begins!!! Staying healthy may seem to be more difficult, yet with foresight and careful attention to possible gynecologic risk factors in aging, these years can be very happy and active for couples and for women themselves. It is important for these women not to think of their symptoms as “just aging.” Most of the “golden years” symptoms are manageable. Life should stay full. It is never too late for healthy habits!

If a woman has worked on her pelvic support earlier in her life, the risk of pelvic floor prolapse or relaxation is minimal. If she has managed her stress levels and mood, or any possible chemical imbalances, and her face shows a smile and her eyes see happiness around her, she is in a better position to lead a happy and fulfilling life. If she has focused on stretching and exercise to help prevent osteoporosis, her posture is elevated and body is free from unnecessary tension.

You may say that these goals are idealistic. Please believe me when I say that “not everything that is idealistic is far from reality.” We all have some risks and some things are inevitable, but if we can listen to our bodies, they will work beautifully for us, both at at happy times and at difficult ones. Please ask some of our patients in their 90s and even 100, they are living proof that this is possible.

While developing healthy habits and following your doctor’s instructions, please remember that ovarian and uterine cancers are most frequently seen in women in their 60s and 70s. Both vulvar and vaginal oncologic malignancies are at their highest risks as well. Thus, it is imperative to take measures for appropriate preventive evaluation at this age. Do your periodic pelvic and breast examinations and do not forget about the tremendous benefit of transvaginal ultrasounds. At Academia of Women’s Health, we believe that regular ultrasound screening should be the standard of care. Many lives have been saved using this additional tool that allows us to screen your pelvis and see structures otherwise not detectable by pelvic examinations.

If problems are identified early, so much can be done to keep our patient’s happy and healthy during this exciting, mature time of life.

Many women experience a new call for intimacy in their existing or new relationships. Our commitment is to your health, and we discuss all medical factors involved.

If sexual intimacy and intercourse are not contraindicated for a couple, we successfully treat patients with the MonaLisa Touch laser. Conditions such as vaginal atrophic changes/dryness, lichen sclerosis, and associated painful intercourse have all been treated with MonaLisa Touch®. We are highly selective, experienced, and successful in the use of the MonaLisa technology and have seen many patients for whom intercourse has now become a part of their fulfilling reconnection with their loved ones.

Life again begins!

And finally, thank you so very much for your attention to our philosophy and approaches essential to comprehensive care for our patients.

To schedule your consultation or visit with Dr. Stepanian, please call Academia of Women’s Health and Endoscopic Surgery at (404) 549-3224.