The operation removed her uterus and cervix, and the actress has since expressed an interest in adopting in the future.

By Faith Brar
Updated: February 16, 2018

Lena Dunham has long been open about her struggles with endometriosis, a painful disorder in which the tissue that lines the inside of your uterus grows outside onto other organs. Now, the Girls creator has revealed that she underwent a hysterectomy, a surgical procedure that removes all parts of the uterus, hoping to finally end her decades-long battle with pain, which included nine previous surgeries. (Related: Lena Dunham Opens Up About Struggling with Rosacea and Acne)

In an emotional essay, written for the Endometriosis Foundation of America, featured in the March issue of Vogue, the 31-year-old shared how she finally came to the tough decision. She writes that knew that going ahead with a hysterectomy would make it impossible for her to have children naturally. She could opt for surrogacy or adoption in the future.

Dunham says her breaking point came after "pelvic-floor therapy, massage therapy, pain therapy, color therapy, acupuncture, and yoga" did nothing to help her pain. She checked herself into a hospital, essentially telling the doctors she wasn't leaving until they were able to make her feel better for good or removed her uterus entirely.

For the next 12 days, a team of medical professionals did what they could to relieve Lena's pain, but as time wore on it became clearer that a hysterectomy was her last-ditch option, she explains her essay for EFA.

Eventually, it did come down to that, and she moved forward with the procedure. It wasn't until after the surgery that Lena learned there was truly something wrong with not just her uterus but her reproductive system as a whole. (Related: Halsey Opens Up About How Endometriosis Surgeries Affected Her Body)

"I wake up surrounded by family and doctors eager to tell me I was right," she wrote. "My uterus is worse than anyone could have imagined. In addition to endometrial disease, an odd humplike protrusion, and a septum running down the middle, I have had retrograde bleeding, aka my period running in reverse, so that my stomach is full of blood. My ovary has settled in on the muscles around the sacral nerves in my back that allow us to walk." (Related: How Much Pelvic Pain Is Normal for Menstrual Cramps?)

Turns out, this structural anomaly of her uterus might actually be the reason she suffered from endometriosis in the first place. "Women with this type of situation may have a unique predisposition to endometriosis because some of the uterine lining that would normally come out as menstrual bleeding flows into the abdominal cavity instead, where it naturally implants causing endometriosis," says Jonathan Schaffir, M.D., who specializes in obstetrics and gynecology at The Ohio State University Wexner Medical Center.

But could Lena have done anything else to avoid the extreme procedure (and subsequent fertility repercussions) at such a young age? "While a hysterectomy is ordinarily a treatment of last resort (or at least, late resort) for endometriosis, for women in Lena's situation, less invasive therapy options may not be helpful and a hysterectomy might be the only effective treatment," says Dr. Schaffir.

While hysterectomies are relatively common (about 500,000 women in the U.S. undergo hysterectomies every year) it's worth noting that they're pretty rare among women as young as like Lena. In fact, only 3 percent of women between the ages of 15 and 44 undergo the procedure every year, according to the Centers for Disease Control and Prevention (CDC).

If you have endometriosis (or suspect that you might), it's important to have a talk with your ob-gyn and M.D. before deciding to undergo such a life-changing procedure, says Dr. Schaffir. Other potentially effective treatments include "hormonal therapies that suppress menstruation or surgery that removes endometriosis implants, that will still allow a woman to maintain her ability to become pregnant," he adds.

The likelihood of Lena carrying a child on her own after the procedure is close to none, which has to be a tough reality to accept considering she writes about always wanting to be a mom. "As a child, I would stuff my shirt with a pile of hot laundry and march around the living room beaming," she wrote. "Later, wearing a prosthetic belly for my television show, I stroke it subconsciously with such natural ease that my best friend has to tell me I am creeping her out."

That isn't to say that Lena has totally given up on the idea of motherhood. "I may have felt choiceless before, but I know I have choices now," she shared. "Soon I'll start exploring whether my ovaries, which remain someplace inside me in that vast cavern of organs and scar tissue, have eggs. Adoption is a thrilling truth I'll pursue with all my might."

In a recent Instagram post, the actress addressed the procedure once again and shared the outpour of "overwhelming" and "heartening" support that she's received from fans as well as the emotional toll it's taken. "More than 60 million women in America are living with hysterectomies and those of you who've shared your plight and perseverance makes me feel so honored to be in your company," she said. "Thank you to the village of women who took care of me through this entire process."

"I have a broken heart and I hear those don't mend overnight, but we are linked forever by this experience and our refusal to let it hold any of us back from even the grandest dreams."

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