I’m losing my uterus soon. I say “losing” instead of, for example, “having removed” because it feels like a loss—the end not just of any remaining fertility I might possess but of a marker of my maturity that has existed for almost forty years.
I got my period when I was thirteen. I was prepared for it, or so I thought. I knew that period products had evolved beyond the pads attached to belts described in that most seminal of children’s chapter books, Judy Blume’s “Are You There God? It’s Me, Margaret.” Now they just adhered to your underwear.
There were also tampons. I once made the mistake of practicing inserting one. When it was time to remove it, I reflexively tightened my pelvic muscles, making extraction all but impossible. Agonizing. My mother came to the door after hearing my cries, but I wouldn’t let her inside the bathroom.
The moment of truth, such as it was, came one day after eighth grade let out. There was slight cramping, and then something thick and brown appeared on my underwear. It was as if, after all that time waiting for menarche to begin, my uterus had turned on me, staining my clothes with something dirty, something that resembled liquid shit.
I would encounter this feeling of having my body betray me again—in a different, more vigorous and crimson, form—some thirty years later.
I can’t tell the story of my hysterectomy without telling the story of why I’m getting one: uterine fibroids—dense, spherical masses of uterine muscle gone awry. I was first diagnosed with them in 2011, when I was in my mid-thirties, at a yearly visit to the ob-gyn. The doctor inserted a few fingers into my vagina and pressed on my lower abdomen with her other hand. “You have fibroids,” she said, and then, when the examination was over, she wrote out an order for a transvaginal ultrasound so that she could get a sense of just how many, and where the masses were situated.
I got the ultrasound (it was less uncomfortable than I’d been warned it would be), and the doctor reported back that the fibroids were everywhere: inside my uterus, outside of it, and within the lining. They didn’t bother me much at that point. Except for difficulty doing twists during yoga class, I didn’t think about them. In fact, for a few years—and probably for reasons having to do with denial, the trauma of going through a divorce, and just not wanting to deal—I forgot about them altogether.
Then, in my early forties, I began bleeding heavily and passing clots the size of quarters. This blood, unlike that of my thirteen-year-old self, was bright red, and it seemed to pour from me like pancake syrup. Even on days I wasn’t bleeding, I felt a heaviness in my abdomen. I dealt with the heavy bleeding the only way I knew how: with enormous, diaper-like maxi pads. (The phrase “sanitary napkins” seems to have fallen out of favor, and we are the better for it.) Often, when things were really looking bad, I’d make sure to check the pads at least once an hour.
In 2015, I finally went to another ob-gyn, this one a specialist in gynecological surgery. After ordering a transvaginal ultrasound and then an MRI, the ob-gyn informed me that the results of both scans were cause for some concern: I had about a dozen fibroids in and around my uterus. Some were the size of kiwis and lemons; others, the size of grapefruits. A few of them were pressing on parts of my upper urinary tract and kidneys, which can increase the likelihood of problems down the line. I was also informed that the sheer volume of the fibroids in my body made my uterus as big as though I were five months pregnant.
I joked aloud that, with all these comparisons to fruit, my uterus sounded like it resembled a gift basket from Harry & David. The doctor didn’t laugh. Instead, she asked me the question that I’d known she’d ask from the moment I sat down at her desk: Did I want children? I shook my head no. I hadn’t wanted to have kids with my ex-husband, and I believed that, if I was ever ready to have children, I’d be “too old” to have them. It was a decision I had made peace with and was comfortable talking about. I would not be someone’s mother.
The doctor mentioned a few options. She said the word “hysterectomy,” and I started to sob and then, embarrassed at the ferociousness of my reaction, sobbed a bit louder. (I tend to cry more when embarrassed about crying.) I hadn’t realized until then that, though I was someone who didn’t want children, I was nevertheless attached to the idea of having a womb.
Fibroids are a not-uncommon malady—and “malady” may not be the right way to put it, because they often don’t have any ill effects. Sometimes they’re so small that they can’t be easily discovered during a routine pelvic exam. Or sometimes they can be, but they don’t cause abdominal discomfort or heavy bleeding. They are most typically found among women in their forties and older, and, for reasons that the medical establishment has yet to understand (probably because the medical establishment doesn’t seem to care much about this), Black women have a higher incidence of fibroids than white women—three times higher, according to statistics. Black women are also three times as likely as white women to get a hysterectomy.
A few weeks ago, a friend sent me a Twitter thread started by the “Daily Show” correspondent Dulcé Sloan that said, “Soooo EVERY black woman has fibroids and no one knows why?!” Tens of thousands of readers engaged with her tweet. Some responded with questions of their own: “DON’T want to know???” Others linked to articles they’d read about connections between fibroids and stress, including childhood abuse. One said, “1. Vitamin D deficiency. 2. Insulin metabolism. 3. Higher estrogen levels. 4. Environmental stressors/toxins.” Then there was the woman who responded, “It’s the food.”
There has been speculation, recently, that the high frequency of fibroid diagnoses among Black women might be owing to Black women’s use of hair straighteners, which have also been connected to diagnoses of ovarian, uterine, and breast cancer. When I heard this news, I freaked out a little bit. I’ve been having my hair—thick, coarse, long, and somewhat unruly—straightened since I was eleven. All that time and money spent chasing after some softer, straighter version of myself—and for what? It felt uniquely unfair, a situation in which Black women’s attempts to achieve a measure of acceptable American femininity might backfire on us in an intimately female way.
So here I was, in a downtown Manhattan office, crying in front of a doctor who had just told me that a hysterectomy was not the only option. We could also try fibroid removal, but there was no guarantee that they wouldn’t come back. I told her that I was willing to undergo a complicated, hours-long surgery in order to save a uterus that, at this point, was bringing me nothing but misery. She appeared not so much unsympathetic as unsurprised. I got the sense that she’d had this sort of conversation many times before.
The surgery took place in 2016, at Mount Sinai. My doctor explained that the procedure, called a myomectomy, would involve the removal of fibroids and their associated blood vessels while leaving the uterus intact—or, in my case, repairing a uterus that, after fibroid removal, was repeatedly traumatized. Myomectomies are not uncommon, and I’m not one to be grossed out, but I felt a wave of nausea when I learned that the removal of my fibroids would make my uterus look, at least initially, a little bit like Swiss cheese.
I spent two nights in the hospital, drugged up with what I can only assume was morphine. I also had a catheter, and pressurized cuffs around my ankles to guard against blood clots. One time, when my dad was visiting, I stood up in my hospital gown to use the bathroom (a nurse had finally removed the catheter), and a gush of blood fell out onto the floor between my legs. Embarrassed, I pressed the call button for assistance; I couldn’t bend over. My dad looked upset.
A few hours later, after I’d settled back into my hospital bed, my ob-gyn came into the room to check on me. At my request, she’d taken a picture of the fibroids she’d removed; I wanted to see just what, exactly, had been growing inside me. In the photograph, I saw some sort of container filled with creamy-white, dense-looking spheres of varying sizes. I joked that they looked a lot like matzo balls. The ob-gyn didn’t think that was funny, either.
Friends who were aware of what I’d been enduring sometimes asked me why I wanted to keep my uterus. Initially, I didn’t have a good answer for them, except because I wanted to. I felt defensive about it. But if I dug a little deeper I had to admit that my reluctance to get rid of it was because it felt important to my identity as a woman.
Of course, this admission complicated other matters. For one, as a feminist, I’m not supposed to attach so much meaning to my reproductive organs—I am more than my uterus, I would probably argue. For another, did this mean I believe that having a uterus makes me a woman? No, I would certainly say. I don’t.
I confessed to two friends that I didn’t know what to make of the fact that, emotionally, I was holding myself to a standard that, intellectually, I don’t hold others to. Their responses were wise.
“I don’t know what I think except that I don’t think any of us has to have a firm opinion about what it means to be a woman,” one said.
The other: “Isn’t it often the case that we can’t believe about ourselves what we can believe about others?”
There were other issues to wonder about. In 2014, after winning a lesson with a famous yoga instructor in a raffle that was part of a reproductive-rights event, I took the subway up to the instructor’s Upper East Side residence. The yogi was an effortlessly beautiful fortysomething woman who appeared on the covers of books and magazines and headlined her own yoga retreats. She had a claw-foot bathtub in the center of one of the rooms that she used as a studio, and curtains that swelled and contracted in the breeze.
When I told the woman that I had a difficult time with twists because of the masses in my abdomen, her look changed, became more . . . knowing. Fibroids, she informed me, are the result of a dysfunctional relationship with one’s father. Did I have a difficult relationship with my dad? she asked, offering me an adjustment as I tried to do my best downward dog. Taken aback, I focussed for a few moments on the mat below, on my hands, spread out beneath me. “I guess I do,” I said. “Don’t we all?”
I don’t remember much about the rest of the lesson. I spent much of it thinking about my dad’s awkwardness, his overprotectiveness, and his anxious tendency to embark on sometimes tedious mini-sermons about this country’s complicated relationship to race. I don’t take much stock in the idea that the interlopers in my uterus are a direct, or even an indirect, outgrowth of the way that I relate to my dad, but the racial element—that I wondered about. (To be clear, the yoga teacher made no mention of race.) I still do. Why, I wanted to know, do Black women contend with uterine fibroids in numbers that other women don’t?
I asked one Black ob-gyn, the Washington, D.C.-based Dr. Sharon Malone, who explained, basically, that we just don’t know. There may be a genetic component, she told me, adding that “not only do African American women in the U.S. have a higher incidence of fibroids but so do women of West African descent around the world.” But enough of just describing disparities. “The bottom line is that we do need more in-depth studies on fibroids with a particular emphasis on Black women,” she said. “It is past time to figure out what we are going to do about them.”
The fibroids recurred, as was predicted. By 2020, four years after my myomectomy, my abdomen was full again.
As with the first time, the biggest clue was increased bleeding, so heavy at times that it soaked my clothes. Even Always Maxi Size 5 Extra Heavy Overnight Pads with Wings—yes, that is a mouthful—would only do so much, and for so long. I had to stuff my car and my bags with pads in case of an emergency, and I desperately tried to avoid long trips or multiple hours away from home in the event that I made a mess. Unlike my first go-around with heavy bleeding, this time I could feel the bright-red blood—that syrup—pouring out of me.
I’ve never been one to be afraid of the sight of blood—who, after years of menstruating, would be?—but I was unnerved by the amount of it. Once, while on a flight from New York to Los Angeles, I pulled down my pants in the cramped airplane bathroom, and blood went flying everywhere—on the walls, on the mirror above the sink, on the door, on my shoes. I cleaned up as best I could and sat in blood-soaked leggings for the remainder of the flight. At home, I’d often wake to find my bedsheets and the mattress beneath stained in red. Eventually, I learned to stretch an enormous towel across the bed to catch any leakage.
Fed up, I went to an ob-gyn in San Francisco (I had moved to the West Coast just as COVID hit), who did a manual exam and confirmed that fibroids had, indeed, returned. She pressed hard on my stomach to get a sense of how many were in there and then ordered blood tests to make sure I was not anemic. (I was.) When she suggested a hysterectomy, I burst into tears—again. As an alternative, the ob-gyn suggested a course of the drug norethindrone, which would work to shrink the fibroids, but, when she mentioned it contains progesterone, I reared back: progesterone makes me feel depressed and highly anxious. I concluded—conceded, really—that a hysterectomy was the only viable option.
The other week, over dinner, I talked to my friend and upstairs neighbor, Nancy, about my upcoming surgery. Nancy is a single, divorced mom; like me, she has a background in women’s media. As her nine-year-old daughter, Riva, sat in the other room, watching “Pitch Perfect 3,” I told Nancy about my complicated feelings around losing my uterus. She said, softly, “Are you feeling this way because you didn’t use it?”
Nancy’s comment sounds harsher than it was. I think she was trying to ask, delicately, whether I regret not having kids. But I think she was asking something else, too: whether or not I was feeling bad about losing my uterus because I didn’t “use” an organ that we have been told our whole lives has one purpose and one purpose only.
In that respect, Nancy’s query was both a personal question and a political indictment—not of me but of the idea of women’s bodies being something other than our own, vessels to be “used” and then, as our fertility ebbs and eventually ceases to exist, dismissed and discarded.
I told Nancy that it was a good question and that I’d think about it.
Hysterectomies, like other surgeries, used to be fatal. This is something I discovered fairly recently, and I was, to put it mildly, horrified by what I learned. In the nineteenth century, between seventy and ninety per cent of hysterectomies ended in death, owing to, among other things, hemorrhage and sepsis. It was only after the First World War, which brought great advances in anesthesia, antibiotics and surgical techniques, that hysterectomies became less fatal. Methods changed in the twentieth century as well. The majority of hysterectomies were done abdominally until the late nineteen-eighties, when a surgeon named Harry Reich pioneered the laparoscopic hysterectomy—and a new era was born. Patients can often go home the same day as their procedure. More than half a million hysterectomies are performed in the United States every year.
There are a few types of the surgery: total hysterectomies, which involve the removal of the uterus and the cervix; partial hysterectomies, which leave the cervix in place (this is what mine will be); and radical hysterectomies, which remove the uterus, cervix, and part of the upper vaginal canal. Do you know anyone who’s had a Cesarean section? Think of a hysterectomy as something like that, except that, instead of a baby, an organ—with its associated blood vessels and muscular attachments—is excised.
In some hysterectomies, the ovaries are also removed. This results in immediate menopause, which is often accompanied by common but difficult symptoms, such as hot flashes, night sweats, irritability, weight gain, loss of bone density, and depression. As I explained to my new doctor a few months ago, I don’t want to be put into menopause unless absolutely necessary. (Perimenopause has been bad enough.)
I will get my fallopian tubes removed, though. Ovarian cancer, it has been found, usually begins there. Upon learning this news, my friend Ayelet texted me: “You have to get your fallopian tubes removed.” I checked with my surgeon, who confirmed that she had been planning to do so all along.
My friend Genevieve had her last period in February, a few weeks before her own hysterectomy. (She also had fibroids.) Genevieve explained, without a hint of irony or regret, that knowing it would be her last period gave her the chance to say goodbye—and good riddance. Like me, she often had . . . accidents. Now, a few months out from her surgery, she said that she’s never felt better: a crushing weight has been lifted up and out.
Another woman, Deborah, said that her hysterectomy was one of the best decisions she’d ever made. (She’d had severe anemia, owing to a condition called adenomyosis, in which the tissue lining the interior uterus grows into the organ’s muscular wall.) A few years after that surgery, she’d had her cervix removed, and, she said, sex is better than ever.
Recently, my friend Katie announced that she wants to throw me a uterus piñata party. “Your uterus has been kind of a dick,” she said. “I want you to write a breakup letter to it and then take a bat to the piñata I’m going to buy and say goodbye to it forever.”
I get that one way to confront a loss like this is to adopt a more celebratory or humorous approach. A few weeks ago, I took a brief glance at Amazon’s Web site. In addition to books about hysterectomies, there are at least half a dozen coloring and activity books (“Don’t Ovary-Act” and “See You Later Ovulator”) and journals (“All My Hysterectomy Shit” and “I’m Sorry Your Uterus Tried to Kill You”). There are T-shirts that say “Peace Out, Cunt” and “Adioso Uteroso.”
I felt empty looking at these. I wished for something that spoke more to the mass of emotions I was experiencing. Something like: “No Uterus, No Peace.”
But I suspect that wouldn’t sell very well.
Later this year, my surgeon, who works out of a minimally invasive gynecological center at Cedars-Sinai, in Los Angeles, will greet me as I lie prone on a hospital stretcher. I imagine that she’ll stand next to me and ask me how I’m feeling and if I have any last comments or questions. I’ll probably start tearing up. Then I’ll be wheeled into the operating theatre, where the anesthesiologist will greet me, and a nurse will check the I.V. port that, with some effort and discomfort, has been inserted into the top of my hand.
Once I’ve been knocked out, my surgeon will open my thin hospital gown and clean my abdomen before making an incision in my belly button and incisions on either side of that. She’ll place a thin tube with a camera on the end inside my navel so that she and the residents and nurses assisting her can get a good look at everything that’s going on inside me. Then, very carefully, through the incisions on the side of my navel, she’ll detach the tissues and ligaments and blood vessels that connect my uterus to the rest of my body and remove the organ, cut into strips. It will be put into a container, which will be delivered to pathology for analysis.
And that will be that.
I imagine that, a few weeks or months after surgery, I’ll feel a sense of relief. No more heavy bleeding. No more anemia. No more Always Overnights, Size 5. But I know that I’ll be grieving, too, for a part of me that feels, even now, as I approach menopause, central to who I am and who I’ve been.
I don’t think that having a uterus is what makes someone a woman. But I’ve come to the conclusion that my uterus is part of what makes me one. As my friend put it, isn’t it common that we can’t believe about ourselves what we can believe about others? I guess that’s what it is. ♦
Sourse: newyorker.com
