Articles about Fibroids and Uterine Fibroid Embolization (UFE)

Uterine fibroid embolization or UFE is one of the biggest medical breakthroughs for women suffering with uterine fibroids. Dr. Lipman and the Atlanta Fibroid Center has one of the world’s largest experience in this amazing procedure . He was the first to perform UFE in Georgia and has treated over 7,000 women over the past 23 years.

Despite the very long track record of safety and efficacy of the UFE procedure, most women suffering with fibroids and seeking help from their Ob/Gyn will not hear about this amazing procedure.

Therefore, the first myth that you may hear from your doctor is “Your only option to treat your fibroids is surgery” (either hysterectomy if you’re not interested in fertility, or myomectomy if you are).

Video: 4 UFE Myths You May Hear from Your Doctor


Why would your doctor not tell you about UFE if they know about this non-surgical option? Quite simply many Ob/Gyns would rather attempt to treat the patient with surgery as they are trained surgeons. But a survey of nearly 1,000 women in the U.S. published in the American Journal of Obstetrics & Gynecology and the Journal of Women’s Health in 2013 revealed that the average time for women suffering with fibroids to seek treatment was over 3 ½ years; with 1/3 of them waiting for 5 years (1).

When they asked the women why they waited to be treated, the majority of them said they did not want surgery. They wanted a non-surgical option, and UFE was not typically mentioned to these women.

The fact that most women suffering with fibroids did not want surgery was surprising to the gynecologists that reported on this data. But not to Dr. Lipman. He sees many women every day in his office at the Atlanta Fibroid Center that are not interested in surgery. They are specifically looking for cutting edge procedures that are safer than surgery, less invasive, have a much quicker recovery, and allow them to keep their uterus.

UFE is a completely non-surgical outpatient option, which treats every fibroid in the uterus and just the kind of procedure these women are looking for. Unfortunately, most women aren’t told about the UFE option.

Myth 1: What [Really] Happens After a Partial Hysterectomy

The second myth is that a partial hysterectomy only removes a part of the uterus. A partial hysterectomy removes the entire uterus and leaves the ovaries behind, whereas a complete hysterectomy removes the uterus AND the woman’s ovaries. The theoretical advantage of a partial vs. a complete hysterectomy is that patients undergoing a partial hysterectomy wouldn’t go in to menopause immediately after the surgery.

However, 1/3 of patients that underwent partial hysterectomy did go into menopause immediately, and another 1/3 of patients went in to menopause early. Removing any part of the uterus for benign fibroids is completely unnecessary and often results in significant psychological (like a man being castrated) and sexual side effects. It also causes significant bone loss and frequent urinary issues (ex. leaking or incontinence); not to mention the 25% surgical complication rate.

Myth 2: You Can’t Have Children after UFE

Dr. Lipman has seen numerous children born after UFE, including three sets of twins. Births after UFE are typically full term and vaginal.

Fibroids and Pregnancy: Miracle Baby

Photo: Doris Combs’ letter to Dr. Lipman nearly 18 years after her UFE procedure at Atlanta Fibroid Center. Read the full story of Doris Combs and her miracle baby.

The surgical alternative is called a myomectomy. This surgical procedure attempts to surgically remove the biggest fibroids from the uterus and then sew the uterus back together. There are a number of issues with the surgical myomectomy. The first is that there are often way more fibroids in the uterus than the surgeon can remove. This means that there are often many fibroids left behind after surgery that will grow, and within 3-5 years the patient will need a second procedure (either the second myomectomy, hysterectomy, or UFE). Dr. Lipman has seen numerous women with more than 2 myomectomies; some with as many as 5 (and they’re seeing him to learn about UFE as a 6th procedure)!

There is never a reason to do more than 1 myomectomy, but if you are unaware of UFE and don’t want hysterectomy, you will likely end up with a myomectomy. A myomectomy has significant effects on a woman’s fertility and there is very little fertility left after 2 myomectomies.

If a woman undergoes a myomectomy and then becomes pregnant, she is obligated to undergo a C-section. This is in contrast to UFE, where the births are typically full-term and vaginal. Therefore, with myomectomy, you will likely end up with multiple surgeries (myomectomy plus a c-section) and still need another procedure in 3-5 years to treat the recurrent symptoms from the fibroids that were left behind at the original surgery (myomectomy). Again, contrast that with UFE and vaginal birth with no surgeries.

Myth 3: You Are NOT Qualified for UFE

The fourth myth is that a woman with symptomatic fibroids wouldn’t qualify for UFE because of the size of her uterus or the number of fibroids that she has. This is completely false. It does not matter how big or how numerous the fibroids are. No matter what your doctor tells you about qualifying for UFE, if you’re a candidate for hysterectomy, you’ll be a candidate for UFE.

Myth 4: You Will Eventually Need a Hysterectomy Anyway

Myth number five is that if you have UFE, you will need a hysterectomy someday anyway. The vast majority of UFE patients find the relief they are looking for and are symptom-free forever; particularly if they are over 40 years of age at the time of the UFE. Younger patients have a longer time horizon until menopause and may grow new fibroids but this is not typical.

The Biggest Myth of Them All: You Don’t Need Your Uterus

If you are not interested in having children at any point in the future, your doctor may imply that you don’t need your uterus anyway. After all, its key function is to bear children, and therefore, if you are not going to have kids, it’s better to “just be done with it for good”. In those cases, your doctor may suggest a partial or a full hysterectomy as an option.

While there are many good reasons for a woman to consider and have a hysterectomy, uterine fibroids are not one of them. We say it with confidence because the truth is that your uterus has a much bigger purpose and role in your life than bearing kids. In fact, its purpose in your body is so important that we will dedicate a separate post to the subject to cover it in detail, but for now, it’s important to mention that removal of uterus can affect your hormonal balance, sexuality, and even personality and overall physical and mental health.

A hysterectomy, whether partial or full, has a 30% complication rate. Many of these are due to bleeding with transfusion or wound issues, but there can also be significant morbidity from cutting important structures during surgery (exs. bladder, bowel, ureter) or even on rare occasion death.

The UFE procedure is much safer than surgery and allows women the relief of symptoms, spares them from the risks and long recovery of surgery, and allows them to keep their uterus.

Conclusion

Choosing the best way for you to treat fibroids is not an easy task. A lot depends on your individual circumstances and needs. But one thing for sure: you want to have accurate information about your options at your disposal in order to make the right choice.  That’s why it’s important to speak to both, your OB/GYN AND an experienced interventional radiologist like Dr. Lipman, to understand what will work for you.

References

(1). Bijan J. Borah, Wanda K. Nicholson, Linda Bradley, Elizabeth A. Stewart. The impact of uterine leiomyomas: a national survey of affected women. American Journal of Obstetrics and Gynecology, 2013; 209 (4): 319.e1 DOI: 10.1016/j.ajog.2013.07.017



Fertility and pregnancy-related questions are at the top of the list when a woman of childbearing age is diagnosed with uterine fibroids. “Will I be able to have kids? How can fibroids affect my pregnancy and fertility? Will I need a C-section? Am I at risk of a miscarriage?” And the list goes on.

To begin with, let’s talk about the impact of fibroids on your fertility. According to The Fertility Institute, the size and location of a fibroid determines whether it will affect your fertility. If a fibroid is inside the uterine cavity or is larger than 6 cm in diameter, then it may reduce the chances of conception by up to 70%. Some of the ways fibroids can affect your fertility are:

  • Uterine fibroids can change the shape of the cervix affecting how many sperm can enter the uterus.
  • Fibroids can change the shape of the uterus interfering with the movement of the sperm or embryo.
  • Fibroids can block fallopian tubes.
  • Fibroid tumors can affect the size of the lining of the uterine cavity.
  • Uterine fibroids can affect  the amount of blood flow to the uterine cavity decreasing the ability of an embryo to implant itself to the uterine wall or develop.

And unfortunately, between 20 to 50 percent of women of childbearing age have fibroids. The good news is that you have options.

Understand Your Options: Pregnancy after Myomectomy vs. Pregnancy after UFE

To learn more about what to expect after myomectomy and UFE, watch the full video “Fibroids and Pregnancy: Understand Your Options“. In this video, Dr. John Lipman of Atlanta Fibroid Center answers the following questions:

  • Should I worry if I am diagnosed with fibroids while being pregnant?
  • Is C-section required after myomectomy or UFE?
  • Can I have a full term birth after myomectomy or UFE?
  • Should I expect a more difficult pregnancy after UFE?
  • Is it safe to breastfeed after UFE?

and other questions about pregnancy and fertility after myomectomy or UFE.

Fertility and Uterine Fibroid Embolization (UFE)

Having a healthy pregnancy and delivery are both possible after UFE. A 2017 study published in the journal Radiology investigated 359 women with fibroids unable to conceive who then underwent UFE. The researchers of the study followed up after an average of about six years. In that time, 149 women, or 41.5%, became pregnant at least once and 131 women gave birth to a total of 150 babies. It was the first pregnancy for over 85% of these women. Of the women with unsuccessful pregnancies, miscarriage was the most common reason.

The researchers concluded that UFE can be recommended to women with fibroids as a treatment option that restores fertility. Since the time of this study, there have been 12 more pregnancies resulting in two ongoing pregnancies and eight live births.

Related Video: The Miracle Baby of Doris Combs

Doris Combs had a UFE in 1997; her son Jalen Comb Jackson was born in 2001. Read the full article “My Miracle Baby: an Amazing Story of Doris Combs“.

A recent study published in the International Journal of Biomedicine showed that the frequency of pregnancy and delivery complications among women who have had UFE for fibroid treatment isn’t significantly different from healthy women without fibroids. What’s more, these complication rates were much lower in comparison to women with fibroids who haven’t had UFE but were treated with either medical therapy or had no other treatment at all.

Making a Decision That Is Best for You

At the end of the day, it’s important to choose a treatment option that is right for you.  It’s important to research and understand all pros and cons of each procedure and discuss your unique situation with experienced doctors (yes, in plural!). Due to the fact that myomectomy is usually performed by an OB/GYN and UFE is performed by an experienced interventional radiologist, you  should seek expert advice from both specialists to fully understand how myomectomy and UFE can affect your fertility.



By Doris Combs
Powder Springs, Georgia

All my life, I knew I wanted children. But in my mid-twenties, I started to experience heavy menstrual bleeding. My gynecologist diagnosed me with uterine fibroids, and that’s when my dream of having a family came crashing down.

He told me I’d never be able to have children and that my only option was a hysterectomy. This was unacceptable to me. And so I waited.

My fibroids continued to take a toll on my life. I bled excessively during my period and because of this, no matter where I went, I had to be prepared. I learned to be prepared. It became my norm to carry and change pads constantly, and it only got worse. It was a lot to take care of, and it made me nervous.

Living a life with such severe symptoms wasn’t for me. It was time I changed gynecologists. Once again, my new gynecologist diagnosed me with uterine fibroids. But unlike my initial experience, we discussed my fibroids in depth, and he made sure I understood my condition. I grew to trust him. I continued to get regular checkups, each time measuring my fibroids to see if they grew. As time went on, my fibroids got bigger, and we knew something had to be done.

The year was 1997, and this time, there would be no talk of surgery. This time would be very different. My gynecologist introduced me to a minimally invasive cure for my fibroids—uterine fibroid embolization (UFE). It all sounded too good to be true, so I didn’t initially say yes. I took my time thinking about this new treatment option. Finally, after months of consideration, I made an appointment with Dr. John Lipman, the interventional radiologist my gynecologist had recommended and a renowned expert in UFE.

At my consultation appointment, Dr. Lipman explained the UFE procedure and answered all of my questions. And I had to ask:

Is It Possible for Me to Have UFE and One Day Have a Child?

He explained all the risks involved, but that ultimately it was possible for me to become pregnant and give birth. I did my own research, trusted his judgment, and chose UFE.

Video: Doris Combs speaking about her decision to have the UFE procedure; pregnancy after the UFE.

The procedure went well. All I remember was lying in bed, falling asleep, and waking up to Dr. Lipman telling me it was over and everything was fine! There was slight discomfort, but I was given medication to ease any pain. Two days later, I was up doing what I normally do.

My life changed drastically after UFE. My periods became normal, and I no longer had to carry around all that extra padding that was once weighing me down. The feeling of being carefree after UFE was wonderful.

What came next could only be described as a dream come true. A couple years after UFE, I became pregnant with my son. My pregnancy went well, and labor was uneventful. I also avoided surgery again by delivering vaginally a very healthy baby boy. That was 18 years ago.

Fibroids and Pregnancy: Miracle Baby

Today at 53, I look back at my choice to have UFE. Not only did it give me my son, but it also gave me back my life. As a woman working a full-time job, the fact that it’s an outpatient procedure with a quicker recovery time worked best for me. Since I had UFE, my symptoms never returned, and I didn’t need any additional treatments. I also avoided 2 surgeries (myomectomy and c-section) which may have led to a lot of other issues afterwards (exs. scar tissue, adhesions, other surgical complications).

Related Video: A Patient’s Husband Speaking about Fibroids and Pregnancy, Pregnancy after the UFE

My advice to women who are having fibroid symptoms and considering UFE is to get to know your gynecologist and interventional radiologist—and get to know them well. Make sure they are open and receptive to any questions you have. This is why both doctors gained my trust. When it came to the actual UFE procedure, Dr. Lipman answered questions I didn’t even know I had! Trust your doctors and trust yourself. UFE was a great experience for me, but making sure you have all the information first will make the process that much better.

UFE vs. Myomectomy: What to Expect When You Get Pregnant

By Dr. John C. Lipman, Atlanta Fibroid Center

Despite performing Uterine Fibroid Embolization (UFE) for over 20 years, my patients often refer to the procedure as “surgery”. UFE does not involve any surgery whatsoever.

Many patients have had previous fibroid surgery; most notably a myomectomy. This surgery can be performed laparoscopically through small surgical incisions or by a longer traditional surgical incision (referred to as open myomectomy). There are often many more fibroids in the uterus that cannot be removed surgically (either laparoscopically or open) and therefore, when the patient wakes up from myomectomy, there are living fibroids left in her uterus which will start to grow.

That is why the myomectomy surgery often commits the woman to having another procedure; typically within 5 years of the original myomectomy surgery. One other drawback of myomectomy surgery is that if the patient does get pregnant after surgery, she would be obligated to have a caesarean section (i.e. another surgical procedure). To summarize, for patients suffering with fibroids who choose myomectomy, they are looking at 2 or 3, perhaps even more surgeries. One additional thing women need to consider when contemplating myomectomy is that a small percentage of patients will convert to hysterectomy during surgery. Therefore, they go in to surgery thinking they will have a myomectomy only to wake up from surgery having undergone a hysterectomy, usually due to bleeding during surgery.

Contrast this with the UFE procedure. UFE is completely non-surgical. There are no surgical wounds and no risk of hysterectomy. Instead, there is a tiny nick in the skin overlying the top of the right leg (or left wrist) which is covered by a regular bandaid at the conclusion of the procedure. UFE typically treats ALL of the fibroids in the uterus and therefore is usually only needed once. Most women treated with UFE will be in menopause before they could ever grow any new fibroids. If a UFE patient gets pregnant following UFE, the birth is typically full-term and vaginal.

Therefore instead of 2 or 3 (or more) surgeries for the myomectomy patient, the UFE patient has NO surgeries! Which route would you prefer?

To hear more about UFE, call 770-953-2600 to schedule a time to speak with Dr. Lipman.



For many women with fibroids, the desire for future pregnancy is an important part of the fibroid treatment decision-making process. If you’ve been told surgery is your only option, keep reading. Uterine fibroid embolization (UFE) is a minimally invasive procedure with an approximate 90% cure rate that research also shows can be a safe option for women who... <a href="https://atlii.com///will-able-baby-ufe/"> [Continue Reading]</a>


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John C. Lipman, MD, FSIR
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