So, Lena Dunham got a hysterectomy: a medical opinion

So, after aimlessly browsing on the web this morning, I came across this article on The New York Times.

Lena Dunham is an actress, director, show runner of Girls and a…polarizing public figure, to the day the least. I’ll start by saying I don’t have strong feelings about Dunham either way: I never watched Girls, and although I find most of what she seems to get in the news for…problematic (some intensely so, but that’s not what this is about), but I’ve never dedicated that much time to thinking about her as a person.

Still, as a medical professional I wanted to add my two cents on the subject. Endometriosis is a condition where your inner lining of your uterus (your endometrium), grows in places it shouldn’t outside of your uterus. This could be your bowels, your bladder, or other organs, and because this tissue is still endometrial tissue, it bleeds and sheds when you get your period. Women with endometriosis tend to suffer awful pelvic pain, especially with menstruation, can develop ovarian cysts and masses, have abnormal bleeding and suffer fertility issues. Endometriosis has no cure, and it has a serious impact on quality of life.

Endometriosis is typically treated with birth control, to suppress the shedding of your uterine lining and thus minimize pain. Oral pills, injectables or IUD’s can be used, as well as a very strong “medical menopausal” drug called lupron, which comes with its own downsides (menopause increases your risk of osteoporosis and heart disease). Surgically, endometriosis is usually treated laparoscopically (minimal invasive surgery) for adhesions or cysts, or to ablate the tissue.

Now, I’m not a medical professional involved in Dunham’s cause, but several articles make it clear that Dunham was having a really rough course of it. She had many surgeries for adhesions and reported severe pain. Most articles also note that she requested the hysterectomy against the advice of her doctor, and the likely reason why for that is that hysterectomy isn’t a cure of endometriosis. Given that the tissue is already outside of the uterus, and that you will never be able to get all of the micro invasions out no matter how talented the surgeon, as long as you still have ovaries producing hormones you will likely still have endometrial growth. And again, at 31 there are significant downsides to taking the ovaries, and no surgeon I know would do that for endometriosis.

Medically, I wanted to make this post to say that Dunham’s decision is not one that endometrial suffers should look at as a good option for themselves: a hysterectomy that young can also have increased risk of cardiovascular disease on top of being very unlikely to actually solve the problem. But that’s her decision, and she had the right to make that decision, which undeniably came at a huge personal struggle. Dunham mentions she had always wanted children, so to end the option of carrying her own child was undoubtably a difficult one.

Socially, I wanted to make this post because of tweets (usernames and pictures removed) like this I found when scrolling down her name on Twitter:

Celebrating the “sterilization” of a woman you don’t agree with is your right as a person with freedom of speech, but it’s pretty damn messed up. People with endometriosis can suffer immensely, and celebrating a tough medical and personal decision someone felt like they had to come to in order to live their life to the best of their ability is a real failure of character and a distinct lack of empathy. As soon as you say something like that, you automatically give up the moral high ground, and you belittle the suffering of others with this condition.

So look, that’s my two cents. I don’t think she made a wise medical decision, but it was her decision, and I do not support people who are responding like that to this situation. Lena Dunham and her life is totally independent of the decision we make to act as empathic humans or not, and I’m personally all for being a little more kind in this mean media world.

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