John Lipman, MD, FSIR, is determined to crack the fibroid puzzle.
Uterine fibroids, a specific type of benign tumor that occurs in the cells of the uterus, affects 70% of white women and 80% of Black women by the time they are 50 years old. Fibroids may create menstrual complications, severe pain, abdominal enlargement and sexual side effects. Yet, most women have never heard of uterine fibroids and few think they are at risk for them. This means patients are largely in the dark about their options for treatment when they are diagnosed.
Dr. Lipman has practiced in Atlanta for the past 31 years, and much of that time has been spent in his private practice, focusing on women’s health—primarily uterine fibroid treatment through uterine artery embolization. By essentially removing the blood supply needed for fibroids to grow, uterine artery embolization (UAE) can improve symptoms, provide better quality of life and possibly preserve fertility. UAE is, to Dr. Lipman, a gift. A crucial part of the fibroid puzzle.
A nonsurgical alternative
“Hysterectomy is the second most common surgery performed in the United States,” Dr. Lipman said. “That’s surprising to me, because half the population of the United States wasn’t born with a uterus.”
Even more puzzling, he says, is that the most common reason for hysterectomy isn’t cancer: it’s fibroids, a benign disease. The average age of hysterectomy is 40 years old.
“Why in the world are we essentially amputating young women for benign disease?” Dr. Lipman asked. “When you diver deeper and consider that African-American women disproportionately suffer from fibroids, you then have to wonder, why are we amputating so many young Black women for a benign disease?”
To Dr. Lipman, the answer to these questions is simple: women are undergoing invasive hysterectomies because they’re not being educated on or offered an alternative.
“We have a tremendous procedure in UAE,” he said. “It’s well proven, safe and effective. We have 25 years of scientific research and medical papers and peer-reviewed publications showing this, which is more than any other fibroid treatment option has received.”
It’s frustrating to Dr. Lipman that patients aren’t receiving UAE, a nonsurgical outpatient procedure with a 90% success rate, and instead are undergoing hysterectomies.
“Yes, it ends the fibroid problem, but it opens up other complications,” he said. “Sometimes the cure is worse than the disease.”
Over the last 25 years, Dr. Lipman has repeatedly heard about the complications of hysterectomy, both through the eyes of those who have undergone the procedure, as well as those who have seen the impact of hysterectomy on loved ones.
“Patients have seen their mom, sister, aunt, best friend, etc., deal with hysterectomies, and they don’t want that result for themselves,” he says.
Dr. Lipman has heard of countless side effects, from sexual dysfunction, bone loss and even urinary leaking.
“Go to any place that sells adult diapers and look who is on the package. You won’t see Grandma. You’ll see a young Black woman,” he said. “Why? Because so many young Black women have had hysterectomies, that they are now a target demographic.”
In his office, Dr. Lipman has a magazine ad for a popular adult diaper brand showcasing a young Black woman pulling jeans on over a diaper, alongside the phrase, “They’ll never know your secret.”
“I don’t want it to be a secret,” Dr. Lipman says. “I want to know why this woman needs an incontinence aid.”
Dr. Lipman points to this ad while educating his patients on fibroid treatment options and cites it regularly during his quest to educate as many people as possible about alternatives to surgery.
“Hysterectomy is an option, but it should be the option of last resort,” he said. “But for so many women, they’ve been told that this is their only option. So, they either undergo invasive surgery, or, instead of getting treatment, they try to push through and suffer in silence.”
This is because many women don’t know about UAE, or—according to Dr. Lipman—they may be given misleading information from their provider about their candidacy depending on fibroid volume. Eligibility for UAE varies for each patient, though Dr. Lipman says the majority of those who are advised by their gynecologist to seek a hysterectomy for fibroids are in fact viable candidates for UAE.
“There are patients where it may be best to pair UAE with a hysterectomy, or simply seek a hysterectomy alone, such as those with massive uterine size or very large pedunculated fibroids,” he said. “But regardless, we need to let women know they have options.”
Looking for research
The other part of the puzzle is fibroids themselves.
While the research supporting UAE is clear, research into the actual pathology of fibroids is lacking, Dr. Lipman says.
“We don’t know where they come from,” he said. “It affects so many women—up to 80% of African-American women—and yet there’s very little funding for research into why.”
According to Dr. Lipman, although fibroids cost society an estimated $35 billion per year, only $18 million is spent each year on fibroid research. “That’s only $0.70 per person for fibroid research,” he said.
Solving the puzzle
Dr. Lipman is passionate about educating on fibroids—but he was eager to do something more. Something bigger.
“I put my money where my mouth is,” he said.
In 2023, Dr. Lipman gifted SIR Foundation a substantial sum to fund fibroid research and awareness. This gift will fund two new initiatives through SIR Foundation: a grant in honor of Scott C. Goodwin, MD, FSIR, and a fibroid and adenomyosis research summit in honor of James B. Spies, MD, FSIR.
Dr. Lipman was insistent that these initiatives should carry the names of two IRs who have made tremendous impact in the space.
“Scott and Jim have been leaders in this effort,” he said. “Scott published a seminal paper in the Journal of Vascular and Interventional Radiology and worked with the first set of patients to undergo UAE (in the US). He and Jim were both the driving force of the fibroid registry as well, which created the largest amount of fibroid data ever collected. And Jim established a quality-of-life questionnaire that's specifically validated for fibroid symptoms. Jim's work was funded by a grant from the SIR Foundation, and this is exactly the kind of results I hope will come from these two new initiatives.”
Not only are Dr. Spies and Dr. Goodman luminaries in the field, but they’ve also been friends and mentors, Dr. Lipman said.
“I was able to participate in the fibroid registry, despite being in private practice, through their kindness, and it really helped me develop my passion in this area,” he said. “I wanted to thank them for the opportunity and the gift of their friendship, while recognizing their work.”
The research summit will gather leading experts to identify areas where research is most needed, as well as explore and discuss larger issues surrounding fibroids like loss of fertility or health equity.
“We can all learn from each other, and people around the globe are doing different things,” he said. “People don’t even do UAE exactly the same, and we really need to validate best practices.”
The grant will support investigators as they pursue fibroid and adenomyosis research. This research will not only validate IR therapies but serve as further educational opportunities for patients and physicians alike.
“Pretty much everything we do is so unrecognized by the public, and that leads to patients missing out,” Dr. Lipman said. “We need to do a better job explaining what we do and who we are, because that will help us break through the gatekeepers and become an option that patients and referrers think about.”
Continuing fibroid awareness will be key, especially when partnering with gynecologists, who are the first stop for patients with fibroid symptoms. Dr. Lipman is grateful for the awareness that his fibroid practice has in Atlanta and has built good relationships with his local gynecologists—but that’s not the case everywhere.
“That’s why we need a national effort to educate on IR in general, but also focus on how life-changing procedures like UAE can be,” he said. “This is one of the biggest medical breakthroughs for women, particularly Black women—and they don’t even get to know they have a choice.”
The future of fibroids
Dr. Lipman hopes his donation will make an impact and spur on even more research funding.
“You might be in a private practice setting and wonder why you should care about research. But research is what validates what you’re doing. It’s what creates the therapies you offer your patients,” he said. “We’ve got to validate what we do, and we need everyone’s support. You don’t have to do the research yourself, but you can at least support it.”
