In Her Own Words: Lena Dunham on Her Decision to Have a Hysterectomy at 31

“Hmm, your blood pressure is low. We’ll check that again in half an hour. Is there any chance you could be pregnant? Wait, of course not; you just had a hysterectomy!” The nurse frowns awkwardly as she administers my blood thinners, the shot you get when you can’t even begin to walk, leaving a constellation of needle bruises across the abdomen. I’m getting used to this—the repetition of a mandatory question about my fertility and my half-rehearsed answer, something playful so she won’t feel too awkward about having reminded a very young woman of what she will never have. I’ve tried responses like “Well, wouldn’t that be something?” or “In that case they took out the wrong organ yesterday!” The night before my uterus is removed, my nurse is a model-gorgeous woman, sardonic and odd, like the sidekick on a TV show who producers pretend is less stunning by slapping spectacles on her. I lie in the bed, knees to chest and clinging to a teddy bear, and I make her Google things on the giant computer she hauls from room to room to take patient notes and scan our medication. Despite lots of prepping from my amazing doctors, I want to find out again what they’ll do with my cervix once they remove it, what will it be shaped like, what will its purpose be, and will they leave a hole in it (the answer: no). I ask her to search whether women feel an immediate hormonal drop, like the period from hell minus the period. Lastly, I ask the likelihood of my ovaries’ dying before I can harvest any eggs, of menopause setting in. Of finally losing every part. “Is there any chance you could be pregnant?” she asks as she gives me my meds one last time. “Well, not after tomorrow,” I say. I wish there were a word for when nobody likes your jokes but you make them anyway. I spend twelve days in the hospital before they perform my hysterectomy. During that time, I get very used to the gasp of pity from nurses, doctors, nutritionists, interfaith chaplains—the subtle intake of breath when they look at me, 31 but with the face of a nineteen-year-old, blue-haired with puppy-print pajamas, curled in the hospital bed. I learn not to hate it, that gasp. I realize they are simply sorry. Being sorry for someone you don’t know is kind, even if it feels condescending and like the false utterances of empathy that women on reality TV favor. (I’ve been watching a lot of feuding housewives from this bed. The ones in Australia are really out of control.) The fact is, I never had a single doubt about having children. Not one, since the day I could understand how families were made. And pregnancy was the glorious beginning of that vision. As a child, I would stuff my shirt with a pile of hot laundry and march around the living room beaming. 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. All the men on the crew, usually brusquely focused on their morning duties, are extra sweet and careful with me. They look at me like I am carrying the Messiah, even though my stomach is silicone and ordered from Japan. I feel the innate power of pregnancy, and I look forward to the moment when my stomach swells naturally and isn’t made of the same substance as breast implants. But I know something else, too, and I know it as intensely as I know I want a baby: that something is wrong with my uterus. I can feel it, deeply specific yet unverified, despite so many tests and so much medical dialogue. I just sense that the uterus I have been given is defective. And while I’ve been battling endometriosis for a decade and this will be my ninth surgical procedure, no doctor has ever confirmed this for me. They’ve told me I have a slightly higher chance of miscarriage. They’ve told me not to wait forever to “get it going.” But through the 40-plus vaginal ultrasounds where I’m forced to stare at the black emptiness of my uterus, they say things like “Look at those egg follicles! You better be careful or you’ll have a baby next week!” Their goal is to preserve my fertility. That is what they consider to be their job. And I laugh and smile, but I know that the blank space, the black hole that is an empty womb captured on-screen, is all I’ll ever see. In August, the pain becomes unbearable. I am delirious with it, and the doctors can’t really explain. The ultrasound shows no cysts, no free fluid, and certainly no baby. But that doesn’t help the fact that it hurts so bad that the human voices around me have become a sort of nonsense Teletubbies singsong. With pain like this, I will never be able to be anyone’s mother. Even if I could get pregnant, there’s nothing I can offer. From August to November I try desperately to manage this new level of pain. I try so hard it becomes a second job. I go to pelvic-floor therapy, massage therapy, pain therapy, color therapy, acupuncture, yoga, and a brief yet horrifying foray into vaginal massage from a stranger. I am determined to outmaneuver whatever is eating me from the inside. But I can only run so well with cement blocks strapped to my feet. Finally I ask my doctor if my uterus needs to come out. She says, “Let’s wait and see.” Two days later (which has always been my definition of “wait and see”; I am not a patient girl) I check myself into the hospital and announce I am not leaving until they stop this pain or take my uterus. No, really, take her. They don’t contemplate this request lightly, doctors. Medical-malpractice suits are real, and women are attached to their uteruses (for me, an almost blind, delusional loyalty, like I’d have to a bad boyfriend). Sometimes it takes a while for the reality of infertility to set in, the rage. The doctor needs evidence he’s operating on someone resolved enough to give consent and never take it back. And so, while I am on what is essentially medical-grade heroin to handle the pain (impossibly addictive drugs are obviously not a long-term solution for me), I write a 1,000-word essay on why, given the circumstances, I’m sure I can handle losing my uterus before I turn 32. “I know that a hysterectomy isn’t the right choice for everyone,” I write, “that it’s not a guarantee that this pain will disappear, and that you are performing it due to your deeply held, essential and—to my mind—feminist belief that women should be able to make a choice about how they want to spend their childbearing years.” My family just wants to see me happy again. They are, for the first time after all my shenanigans, truly scared, and my father checks my breath as I sleep, leaning close to my chest. I apologize weakly for what they are witnessing—someone who hurts too much to express themselves, who can’t help but be a nuisance at best and a terror at worst. My beautiful partner, who has seen me through so much pain with compassion and care, has to be away for work, and I can feel us growing slowly apart, since life is so determined to display its full complexity right now. I am surly and distant. I offer nothing. He reminds me again and again that I am still a woman and still alive, but I also know that soon—for so many reasons that have nothing to do with my uterus—we’ll slip away from each other and I will face everything I am losing in impossibly tiny steps. My therapist writes a note. I talk to another therapist my doctor favors, who suggests three more sessions to get at any “deep-seated ambivalence.” All the while I writhe in pain and mutter Girl, Interrupted–style musings at the interns who stop in to see me. I choose one particular doctor as my target, just to stay alive and focused. “How old are you?” I demand to know, “and where do you live?” This has to be some kind of reverse HIPAA violation, but he tells me he’s 27, which enrages me. What does he know about life? When has he ever felt this pain, this illusion of choice? Why does he always greet me by saying “good afternoon” even when it’s clearly nighttime? He’s stingy with pain medication and asks why I don’t just go home and wait for my surgery there. Six days into my stay, in a final attempt to quell the pain without removing my uterus, a procedure is performed, a dilation and curettage (like a termination minus a fetus), but it doesn’t go as expected and I end up in a recovery bay on an IV drip of Pitocin, the drug used to induce labor. They need my uterus to contract—but once again it won’t comply, for complex medical reasons I can’t understand, so right now I am essentially in labor for seven hours, my back seized, grunting like a creepy dude in a tennis match. It’s not lost on me that this is the closest I’ll ever come to birth and here I am with a nurse from Staten Island who wonders aloud why I am so often nude on television. If there is any upside to this irony, by the end it seems as if my doctors may finally be ready to concede that my uterus really is a bad seed. It appears normal, cheerful in blonde pigtails like little Rhoda the evil child from the classic film, but it’s angry, exhausted, a home for no one. The morning of the surgery, my favorite nurse-sidekick wakes me up at 6:00 a.m.—a sweetly familiar presence, with Wayne’s World tattoos on each foot and a son she had young because she believes in taking chances. “You ready?” she asks. I am holding back tears but also doing a stand-up routine as my family walks behind my gurney, headed to the operating room. “Hey, who here feels like giving up their uterus? I hear there’s a two-for-one sale on the operation. Dad, join me?” I want to cry so badly, but I know it’s not welcome here. My sobbing could easily be seen as doubt and reverse it all. I am already mourning, but I am not in doubt. In the operating room the lovely Haitian anesthesiologist, Dr. Lallemand, lets me select a favorite Rihanna song, and I try to absorb the gravity of the moment—at least a dozen people dressed in blue scrubs with face masks, the fact that I could run right now but instead I am choosing to stay, choosing this. I have to admit I am really choosing this—I gave up on more treatment. I gave up on more pain. I gave up on more uncertainty. The medication enters my bloodstream, and my vision blurs pleasantly. I won’t have to feel for a little while. I wake up surrounded by family and doctors eager to tell me I was right. My uterus is worse than anyone could have imagined. It’s the Chinatown Chanel purse of nightmares, full of both subtle and glaring flaws. In addition to endometrial disease, an odd humplike protrusion, and a septum running down the middle, I have had retrograde bleeding, a.k.a. 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. Let’s please not even talk about my uterine lining. The only beautiful detail is that the organ—which is meant to be shaped like a lightbulb—was shaped like a heart. Back in my room I hurt in surprising places: my shoulder, my hip, my ankle bone. It’s been a few months now. Despite some small complications (please remember to drink lots of water; that’s my only advice) I am healing like a champ. I have a limp, the result of a pinched nerve in my pelvis, but I rock it like the new Balenciaga boots I bought myself as a push present. My mind, my spirit, are another story. Because I had to work so hard to have my pain acknowledged, there was no time to feel fear or grief. To say goodbye. I made a choice that never was a choice for me, yet mourning feels like a luxury I don’t have. I weep, big stupid sobs, alone in the bathtub or in the area where, in a terribly cliché turn, I have started crafting. Many of my friends are pregnant, or trying. I was worried I’d handle it badly. Turn quietly bitter. Drink too much champagne at the baby shower. Sad old Aunt Lena. But I treasure them each. I cannot wait to meet their children (and quietly mock any Hollywood baby names, which I would have done were I fertile, too, so that’s fine). Sonograms and Instagram feeds don’t break my heart like they did when I still had a uterus that didn’t work. The children who could have been mine do break my heart, and I walk with them, with the lost possibility, a somber and wobbly walk as I regain my center. I may have felt choiceless before, but I know I have choices now. Soon I’ll start exploring whether my ovaries, which remain someplace inside me in that vast cavern of organs and scar tissue, have eggs. (Your brain, unaware that the rest of the apparatus has gone, in theory keeps firing up your eggs every month, to be released and reabsorbed into the cavern.) Adoption is a thrilling truth I’ll pursue with all my might. But I wanted that stomach. I wanted to know what nine months of complete togetherness could feel like. I was meant for the job, but I didn’t pass the interview. And that’s OK. It really is. I might not believe it now, but I will soon enough. And all that will be left is my story and my scars, which are already faded enough that they’re hard to find. Click here to learn more about getting a hysterectomy due to endometriosis. In this story:Sittings Editor: Lawren Howell.Hair: Diego Da Silva; Makeup: Romy Soleimani.Produced by Dayna Carney for Rosco Production. More from Vogue See More Stories © 2025 Condé Nast. All rights reserved. Vogue may earn a portion of sales from products that are purchased through our site as part of our Affiliate Partnerships with retailers. The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of Condé Nast. Ad Choices CN Fashion & Beauty

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