Dr. Debra Ravasia, a Spokane gynecologist and owner and founder of Women's Health Connection clinic and Ajuva Medical Spa here, believes there is much more to being a women's health practitioner than simply treating health problems.

Ravasia says she and her staff try to go one step further to address underlying causes of patients' health conditions by helping them make lifestyle changes that might prevent future problems.

Women's Health Connection is located in 3,000-square-feet of space on the third floor of the Northpointe Professional Building, at 9425 N. Nevada, near the corner of Nevada Street and Holland Avenue. The clinic offers a variety of in-office procedures and treatments for women, from permanent birth control to minor surgical procedures, and specializes in the areas of gynecology, urogynecology—the practice of gynecology as it relates to the bladder—and infertility.

Since opening Women's Health Connection five years ago, Ravasia says one of the biggest changes to the practice is her approach to treating patients and, in turn, helping them prevent future health problems.

She says she's noticed that many of the health issues she commonly treats ultimately are caused by patients being overweight.

"A low percentage of muscle and a high percentage of body fat causes a high metabolic condition," she says, which can cause hormonal problems or problems with a woman's pelvic floor, the muscles that control the bladder and the vagina. A high metabolic condition, also known as metabolic syndrome, is the term for risk factors that occur simultaneously as a result of obesity and can cause heart disease, stroke, and diabetes.

Ravasia says that as women age, the muscles in the pelvic area of the body can weaken over time and ligaments also sometimes can be stretched or torn during childbirth.

Damage to the pelvic floor can lead to incontinence, urinary urgency, leaking, and a number of other problems, Ravasia says.

She says one of the main focuses at Women's Health Connection for issues such as urinary incontinence is "going one step further and addressing the metabolic problems and weight problems that go along with it."

To help minimize future gynecological or urogynecological problems in her patients, Ravasia introduced a program to help her patients make healthy lifestyle changes. The two-year-old medical weight loss program, which she oversees, is part of her second women's health venture, Ajuva Medical Spa, which is located next door to the clinic.

Patients who are recommended to the medical weight-loss program there have the choice between two programs, called Ajuva Sprint and Ajuva TLC.

The Sprint program, which costs $295 for the initial visit and $95 for each subsequent weekly assessment, focuses on rapid weight loss with medically-approved weight loss supplements and the use of body composition and metabolic testing. The TLC program, which stands for therapeutic lifestyle change, is focused on continually maintaining a healthier lifestyle, Ravasia says.

It costs $149 for the first visit and varies for each follow-up depending on whether a patient formerly was in the Sprint program. Patients learn healthy eating habits, stress management, sleep and sleep cycle management, and lifetime fitness techniques, she says.

"These programs help a lot in treating these problems," Ravasia says. "We still initially treat patients with the same procedures, but we also take one step back and look at why it happened in the first place, and we can prevent other problems in the future."

Since the weight-loss programs started, Ravasia says Ajuva's clients collectively have lost more than 21,000 pounds. She says most patients in the programs are able to take off 40 to 50 pounds in about three months, which usually is more effective in helping them stay motivated to keep the weight off in the long run.

Since opening Women's Health Connection in February of 2005, Ravasia says she has seen her practice grow from five employees, including her, to more than 25 employees, including another physician, Dr. John Bullis, two nurse practitioners, a licensed massage therapist, and three registered nurse anesthetists. She says the clinic also has added a number of procedures and treatments that weren't available to patients when she opened the practice, such as menopausal management and stress management.

"We want to provide well-rounded care for the whole woman," she says. "We provide complete care with an emphasis on wellness, prevention, and still take a very compassionate approach."

Ravasia says Women's Health Connection serves as a primary-care clinic for about two-thirds of the practice's estimated 6,100 patients. She says Ajuva has about 1,800 patients. Several months after Women's Health Connection opened in 2005 it had about 1,000 patients, she says, adding that most of the clinic's patients are between the ages of 30 and 60.

Expanding the practice's services has allowed it to grow at a mostly steady rate, says office administrator Brenda Hall, but she says changes in health insurance benefits also have presented a challenge in the clinic getting reimbursed for its services.

"We spend a lot of time pursuing payment from our patients, which is frustrating for them because companies are cutting the way they reimburse patients," she says.

An on-site surgical suite also has been added to the clinic and is used for minor in-office procedures such as ablations, "tubals," and several other minimally invasive procedures, Ravasia says. An ablation is a procedure done to remove the inner lining of the uterus that sheds and bleeds every month during menstruation. Tubal is a term given to permanent forms of contraception, in some of which a device is inserted into the fallopian tubes to block sperm from reaching an egg, Ravasia says.

"We are always trying to focus on being on the cutting edge," she says. "These are minimally invasive procedures with little downtime, which most of our patients don't have time for."

Ajuva Medical Spa, which opened in 2007, also provides a variety of aesthetic procedures such as liposuction, laser treatments—including teeth whitening, hair removal, and spider vein treatments—and Botox injections. Ajuva offers traditional spa treatments including facials, massages, and body treatments additionally, Ravasia says.

"Wellness is also a state of mind and aesthetics plays into that a little bit," Ravasia says. She adds that the traditional spa treatments are not a major part of the overall services she oversees at the spa, but says, "It's a fun perk to the practice."