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Lena Dunham has revealed that she has undergone a total hysterectomy, which means that she has had both her cervix and her uterus removed. The actress has been vocal about her battle with endometriosis for some time, but in a new essay for American Vogue, she has opened up about the other problems she was facing.

Endometriosis is a fairly common (affecting about 1 in 10 women) but extremely painful disease, in which the tissue that usually grows inside the uterus grows outside of it. Dunham has spoken about her struggle with the problem on several occasions when she has been forced to take time off work.

This, however, was not the only complication she was suffering from.

“In addition to endometrial disease, an odd hump-like protrusion and a septum running down the middle, I have retrograde bleeding, aka my period running in reverse so that my stomach is full of blood,” Dunham wrote. “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 light bulb — was shaped like a heart.”

Undergoing the surgery means that the actress will be unable to physically carry children, but she is open to exploring other options when it comes to becoming a parent, whether that’s adoption or using her eggs.

“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 the vast cavern of organs and scar tissue, have eggs. Adoption is a thrilling truth I’ll pursue with all my might.”