The Unexpected Grief of a Hysterectomy

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?