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.
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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.
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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 this horrible period, month after month after month. And so many of these women, as I mentioned, suffer with this for long periods because they don't want surgery. So, there's this physical drain on them, but there's also this incredible mental drain, the dread of having to push through all of this.
A lot of women can't take two months off from work. That's what the recovery is from a hysterectomy two months out of work or maybe longer. So they end up just pushing through, just working with this. And it's miserable. Not only is that a mental strain, but they may be the only woman in the workplace. And so men don't understand women's periods. The women feel an obligation not to let the team down because if they miss work or frequently get up from work and go to the bathroom and change, not coming into work or whatever, they feel a sense of responsibility to other women they hire next. Or they may be the only woman of color in the workplace.
Over a million women in the United States are suffering on the sidelines. They don't want surgery. They've only been given surgery as an option, and we could help them with UFE, but they don't know about us. And that's one of the reasons why I was so glad you decided to write about this because you will help so many women you'll never meet.
Q: I just had a quick question to backtrack for a moment. When you mention that little incision, what are you doing exactly when you go in there?
A: The access point is at the top of the right leg. That's where we make a little nick, and the pad of a regular Band-Aid covers it. We go into the artery. I can steer a little catheter the size of a piece of spaghetti, under X-ray guidance, into each uterine artery, one at a time. There are two uterine arteries, one on each side of the uterus. I'm in the tree's trunk, and then the tree branches get smaller and smaller and smaller. So you get out to the leaves; the fibroids are the leaves of the tree. So I'm in the trunk, and I can direct these particles of polyvinyl alcohol (PVA) to plug up every tiny branch feeding the fibroids. The big trunk, the main branches, and the big branches of the uterus are all open, but the tiny branches feeding the fibroids are plugged up without a blood supply. Those fibroids are going to die.
The uterus stays alive. And I've had numerous children born after UFE. I've had multiple twin births. And our births are full term, typically full term and vaginal. Whereas if you have surgery for fibroids, a myomectomy, you'll have to have more surgery and will not be allowed to have a vaginal birth. You'll have to have more surgery, a C-section because they're worried about rupture of the uterus. Once you cut into the uterus surgically, they're concerned that if you get pregnant and have a delivery, your uterus will rupture, so it has to be a C-section.
Another important benefit of UFE over myomectomy is that they never get all the fibroids out surgically. They get the biggest ones. They can only get out safely with several ectomies; unfortunately, they get into too much bleeding trying to get some of the fibroids out. And a myomectomy patient wakes up with a hysterectomy. But even in the ones that do wake up with their uterus, there are always living fibroids left behind. And those fibroids grow, with an 11% per year recurrence rate. So over half the women that get myomectomy need another procedure in five years, and a third within three years. Unlike UFE, where my patients that have it done have all the fibroids knocked out.
So for the vast majority of people, it's a one-time procedure. As the fibroids die, they soften and shrink. And as the softening and shrinking go on, a woman's symptoms disappear. In fact, that's how this procedure got discovered because we've been embolizing tumors for many, many years, usually cancerous tumors, to try to make it an easier operation for the surgeon. So, we'll embolize a patient, let's say, that has kidney cancer; we'll embolize the tumor because it's very vascular. It bleeds a lot. And so, cutting off the blood supply to the affected kidney will make it an easier operation for the surgeon. Somebody in France got the bright idea. I know this isn't cancer. Fibroids are benign tumors, but they're very vascular too. Why don't we embolize these patients ahead of their hysterectomy and make it an easier hysterectomy for them? It made sense.
Now I know that my life's work is, it has been my life's work exclusively for the past 25 years. I've been treating fibroids non-surgically with UFE. It's a tremendous procedure. And it's available nationwide, but we are the leaders in it. We've done more UFE than anyone nationwide and probably worldwide.
Q: So how many, how many patients have you helped in going the UFE route?
A: We've done about 10,000 UFE. Unfortunately, there are somewhere between 600 and 700,000 hysterectomies done every year. So we're only scratching the surface.
Q: So, my last question, I read in your bio that you are on the editorial advisory board of Sharecare. How did you get into that?
A: Well, they asked me. I guess they were looking for a women's health expert. They have a number of different advisors for all these different specialties, internal medicine, pediatrics, urology, and rheumatology. I'm the only radiology person on the advisory board. But you know, as I say, my passion is women's health, but I serve as a radiologist on that board.
Q: Nice. And then, was there anything else that you wanted to add?
A: The main points are that a hysterectomy is not necessary for symptomatic fibroids. It's an option, an option of last resort. Women need to know about all their options. They're entitled to know. I'll hear gynecologists mention, "I told the patient that you could look into UFE, but likely if they have the UFE, they'll still need a hysterectomy." That's false. Typically, it's a one-and-done. You won't need anything else. Occasionally, we'll do a second embolization. Usually, the patient, when we did the first one, was under 40 years of age. And the next time we see them, they're late forties or maybe early fifties. They've gone a long time, but they grew some new fibroids. They're never too big or too many.
Ninety-nine percent of patients that are candidates for surgery are candidates for UFE. Mm-Hmm. It's very rare not to be a candidate. Another myth is that you can't have children, and I've had 60% of the patients that wanted children to get children. And the UFE procedure is done nationwide, and all insurance covers it. So insurance is not an issue. It's not anything new or experimental. There are some new experimental things, but this has been around a long, long time and has a long track record of safety and efficacy. Don't be afraid to get that second opinion, especially from an interventional radiologist like myself.
Thank you for your time. I appreciated all the information given that could help women looking to go the nonsurgical route.
Response: Thanks again for bringing this much-needed story to light!
John C. Lipman, MD, FSIR, is a board-certified Interventional Radiologist and renowned authority in the nonsurgical treatment of uterine fibroids. He received his Masters and Medical degrees from Georgetown University School of Medicine in 1985. He completed a residency in Diagnostic Radiology at Brigham & Women's Hospital, Harvard Medical School. Then he did a Vascular & Interventional Radiology fellowship at Yale-New Haven Hospital, Yale University School of Medicine.
He was awarded the highly acclaimed Fellowship status in both the American College of Radiology & Society of Interventional Radiology, honors that only 10% of Radiologists ever achieve in their career. He has delivered over 200 invited lectures to some of the most prestigious medical centers in the country, including Harvard, Morehouse, Vanderbilt, and Yale Medical Centers. He has served on the Board of Directors of the Medical Association of Atlanta (MAA) and Cobb County Medical Society (CCMS).
He currently serves on the Editorial Advisory Board of Sharecare: an interactive internet healthcare platform founded by Dr. Mehmet Oz and Jeff Arnold (the creator of WebMD). He was an Atlanta Business Chronicle's Health Care Hero of the Year, a "Top Docs" in Atlanta from Atlanta magazine, the 2019 Trailblazer Physician of the Year from the Atlanta Medical Association, the 2021 Vanguard Award for Philanthropy from Morehouse School of Medicine (MSM) and last October was recognized by AmeriCorps and President Biden with a Lifetime Achievement Award for outstanding Community Service.
Dr. Lipman is the Founder & Medical Director of the Atlanta Fibroid Center. This state-of-the-art medical facility specializes in the nonsurgical treatment of uterine fibroids and has cared for women worldwide. He is an Adjunct Clinical Assistant Professor in the MSM Department of Obstetrics & Gynecology.
Website: Atlanta Fibroid Center - Nonsurgical Fibroid Treatment - Dr. John Lipman (atlii.com)
