John C. Lipman, MD, FSIR reached out to me after writing the “Living with Fibroids: Surgery Isn’t The Only Way To Stop Them” article here on Blackdoctor.org, and it was a pleasure hearing about his passion for helping women feel less pain and discomfort when it came to Fibroids. I enjoyed hearing about how women had other options than just getting a Hysterectomy and how many benefits Uterine Fibroid Embolization (UFE) had for women. Below he explains the procedure from A-Z, the recovery time, and how much losing your uterus could affect you.
Q: So John, could you tell me a little about how you got interested in radiology and how that led you to fibroids?
A: Well, interventional radiology uses radiology X-ray or some other form of radiology imaging to guide them anywhere, all over the body, to treat conditions that were once only could be treated surgically. Now, interventional radiologists can treat without any surgery whatsoever. So we can treat aneurysms in the brain without touching a hair on the patient’s head. We can intervene non-surgically in almost pretty much every organ of the body. And that’s what was very attractive to me. It was the cutting edge without the cutting. Mm-Hmm. I mean, it is the coolest medical specialty. We’re the inventors of angioplasties and stents. And you know, we can open up blocked arteries, close bleeding arteries, and treat cancer, peripheral vascular disease, stroke, and aneurysms. In my particular practice, I have a very niche specialized practice in women’s health, particularly in the nonsurgical treatment of uterine fibroids.
Q: So, with fibroids, what drew you to fibroids specifically?
A: I always wondered why we do hysterectomies for benign diseases. I understand the hysterectomy and doing major surgeries for cancer, but it never made sense to me. It still doesn’t make sense to me why we’re doing a hysterectomy for a benign disease. Fibroids are benign tumors, and we have a procedure, Uterine Fibroid Embolization (UFE). It’s one of the biggest medical breakthroughs for women, particularly women of color, who disproportionately suffer from these benign tumors. And yet, if you look racially, African American women are getting hysterectomies for benign tumors, fibroids.
Caucasian women are getting hysterectomies for cancer, which is appropriate. So that begs the question, why are we doing this? Hysterectomy is the second most common surgery done in the United States, which is pretty staggering because half the population of men doesn’t even have a uterus. I’ve met way too many women, less than 30, who have already had a hysterectomy. They didn’t want it but weren’t given UFE as an option. And that’s the biggest problem we have is that most patients that are suffering from fibroids never hear about UFE from their gynecologist. And that’s, that’s just wrong. Women are entitled to know all the options, not just the surgical ones.
Q: Why do you believe that this is a major issue for African-American women, and why is it that we don’t get to hear about nonsurgical treatments?
A: Well, the first part, why is it important? Because fibroids probably affect at least 80% of African American women, more than any other racial group. And so, while it’s important to know about UFE in all women, women of color need to know about UFE. Now, why don’t we know about UFE? Although it’s been present for over 25 years, proven safe and effective, and has been done since the middle of the nineties, it took the American College of OBGYN till about 2008 for them to finally give it the stamp of approval, saying it’s safe and effective for women that want to save their uterus. And I don’t know anybody that wouldn’t want to save their uterus. But it got finalized as safe and effective for women suffering from fibroids that wanted to avoid surgery.
But still, that was 13 years ago. And still, the rank and file are not telling their patients. There was a landmark study in the Journal of Women’s Health. Elizabeth Stewart, chief of OBGYN at the Mayo Clinic, did a study published in 2013, looking at about a thousand women suffering from fibroids. And the meantime, to get treatment was three and a half years. And a quarter of them waited over five years to get treatment. Despite the suffering, why are these women suffering so long? Well, the reason is they don’t want surgery. And they weren’t given any other nonsurgical option like UFE. And so it’s clear that women don’t want surgery no matter what the gynecologist says.
And that’s another myth that the gynecologist kind of talk about to their patients. They say, well, if you’re done having your children, you’re not interested in fertility, you don’t need your uterus anymore. That’s absurd. The uterus has a lot of important functions for women besides just bearing children. Having a hysterectomy can affect women psychologically and sexually, and people don’t want to talk about sexual dysfunction after a hysterectomy, but it’s real, and it’s not uncommon. Women get embarrassed. There’s a lot of bone loss after hysterectomy. There are cardiovascular effects, particularly if the hysterectomy is done before age 50; the earlier, the worse it is. The bottom line, it’s unnecessary. But you ask, why don’t they know? Well, it’s kind of a couple of reasons. Why don’t gynecologists mention it?
Because some gynecologists view this financially, medicine is being turned into a business. So they derive a significant portion of their income from doing surgeries. They’re surgeons. I haven’t met too many surgeons in my career, a 30-plus-year career, that doesn’t like to operate. They love to operate, but in this instance, it’s not necessary. So one part of this, I guess, is financial, but on the other part of this is really the unfortunate and sad history of how we’ve treated women, particularly women of color. I’m in Atlanta, and you can talk about the Fannie Lou Hamers and the Mississippi Appendectomies, and you know, that racial aspect of this, and you can’t ignore it. It’s part of the equation.
And as I say, the bottom line is no matter what your gynecologist tells you, you don’t need a hysterectomy. If you’re suffering from symptomatic fibroids, it’s an option, but it should be the option of absolute last resort because UFE is so good. 90% of patients that get UFE get significant or complete relief of their symptoms. They avoid the risks and long recovery of an operation. And importantly, and often underappreciated by many physicians, they get to keep their uterus and not lose it.
Q: Can you describe to me the process of uterine fibroid embolization? Take me from what you would tell a patient, step one, to the final step.
A: Well, patients will come to the Atlanta Fibroid Center. They will have to be dropped off because they can’t drive once they’ve had the procedure. So somebody drops them off at the Atlanta Fibroid Center. The UFE procedure takes me about 30 minutes or so. They sleep through the whole procedure, but they’re not put to sleep like an operation. There’s no general anesthesia. The sedation is much nicer. After the procedure is over, they’ll recover in their own private room for several hours, and then they’ll go home with a Band-Aid at the top of their right leg where we go in. And their uterus is still intact. Recovery at home is usually about five days. And then, I will see them in a follow-up three months after the procedure. We review their symptoms and ensure they can tell that their symptoms are at least significantly better.
A lot of these women are having these horrific crime scene-like periods, horrible pelvic pain, and urinary frequency. So, a lot of physical effects from the anemia that many of these patients are undergoing. They’re chronically weak and fatigued. Due to the amount of blood loss, they may not work a few days a week. They may not have relations, they may not be able to swim, and they may not be able to go out anywhere. Some people are bedridden, or at least house-ridden, for several days a month. Everything they do revolves around