Saying Goodbye to My Uterus

Dear Uterus,

I am writing this as my final goodbye to you now that it’s been over six months since my hysterectomy and we’ve parted ways. I know it’s a bit unconventional to write a letter to a body part, but a friend thought it might be cathartic in helping me process this life-changing event. So, as silly as it might be, here goes.

Without a point of reference on how to do this, I’m going to start at the beginning of our relationship. Sadly, we’ve had an extremely complex and turbulent relationship for the past 38 years.

I didn’t know much about you until two weeks before my 13th birthday, when I started my period. I admit you made a pretty bad first impression with your bold introduction. You made your presence fiercely known each month when I would feel your spasms as cramps.

In high school, I did whatever I could to get out of school on days I had my period. I’d lie on the cold, tiled bathroom floor with a hot water bottle pressed against my abdomen to quell the pain. Month after month, begging my mom to let me stay home from school so I could lie in bed with my hot water bottle. I relied on over-the-counter pain relievers, popping those little orange pills like candy.

Then one day, sitting in my college Biology 101 class (of all classes!) my period showed up unexpectedly and blood soaked through my pants. I couldn’t take it anymore. A classmate who worked in the medical field said the birth control pill could help.

Ahh — sweet relief. Taking the birth control pill turned out to be a good solution, at least for a while. No more worrying about accidents or having to opt out of plans because of heavy bleeding or pain. Life felt normal.

But 10 years into taking the pill, I had to stop. One of the side effects caught up with me: My liver was unable to process the synthetic estrogen and I developed a benign tumor that required surgery. My doctor advised me to never take birth control pills again. If I was crazy, I might have thought you and your cousin organ were colluding to get me to stop taking the pill. But since I’m a rational adult, I understand organs don’t operate this way.

Once again, my periods were brutal; they came back with a vengeance. I’d lie on the couch, searing pain shooting through me, feeling as if knives were stabbing me from within.

At my annual exam, my gynecologist suspected I might have endometriosis. Since the only sure way to diagnose this was through surgery and she was reluctant to go this route, I left her office with yet another prescription for painkillers.

“Hi, yep, it’s me, calling in sick,” I’d tell my boss. Many of my bosses were male so I hoped they wouldn’t detect a pattern with my monthly sick days. “You really need to be careful not to get fired,” my friends would warn.

And then, in my late 30s, past my fertility prime, I met the love of my life. After a few years of dating, I got married. Finally, my dear uterus, it was our big shot! We had the same objective in sight: Get pregnant and develop a human life. Only this proved to be a challenging goal, perhaps because of suspected endometriosis or because of my “advanced maternal age” as the doctors called it; they never knew for certain. All I knew is now that I was actively trying to have a baby, I couldn’t.

Since I was in my early 40s now, my doctor recommended we do IVF. I’m sure it wasn’t fun for you to get poked and prodded constantly with various IVF-related procedures. I’m willing to bet you hated the attention as much as I did.

When I found out I was pregnant after several IVF attempts, I was thrilled. I was ready for us to work together and knew you’d do all you could to help my baby grow strong and healthy inside of you — his or her first home. Thanks to you, I heard my baby’s first heartbeat, the sound of pure joy. I’ll always be grateful to you for giving me that beautiful memory.

But then, tragedy struck. At eight weeks, I had a miscarriage. After my doctor did a D&C, my cramping made me think you were grieving as much as I was. I felt your cries when I was doubled over in pain.

I was devastated, but not surprised, to learn I’d unlikely ever have a child of my own. I wanted someone or something to blame, and you were the easiest target.

I spent a good deal of time mourning and worked with a grief counselor, talking a lot about you in those sessions. Now my periods were becoming heavier and more painful. I was suffering worse than ever. Each month having a period meant no fetus, yet there I was, lying in the fetal position with a heating pad (I upgraded from the hot water bottle) and prescription strength ibuprofen, trying desperately to calm you down. I wondered how much more painful childbirth could be.

I was planning my life around you, not wanting to commit to events, parties or any social gatherings for fear you’d show up enraged. One month, when my period arrived early, I dragged myself to a concert because I didn’t want to waste the money spent on the ticket. My pale face concerned my husband even after I reassured him I was fine. As I walked slowly to the car after the show, my body weak from so much blood loss, he shook his head. “We should have stayed home,” he said, the regret in his voice unmistakeable.

It went on this way for a few years until a knowledgeable doctor diagnosed me (at the age of 48) with adenomyosis — the “sister” disease of endometriosis. Finally, an explanation for what was causing so much pain and heavy bleeding. In many cases, you enlarge and keep growing up to menopause, sometimes even post-menopause. I’ve seen many images of cartoon uteruses depicted as villains. Angry, frowning faces drawn on a pink organ with fallopian tubes as arms. It says a lot about women’s reproductive health and how so many of us suffer.

Unlike endometriosis, adenomyosis is confined within the uterus and the only definitive cure is hysterectomy. But for all my years of complaining about you, I didn’t want to go this route. At least not yet. I told myself I would hold onto you for as long as possible. In the meantime, I considered less invasive methods, but everything came with side effects or high failure rates.

My yearly gynecology visit revealed you were growing, thanks to the adenomyosis, and at my last MRI you were the size of a five-month pregnancy. Because I was carrying a little extra weight in my midsection, you were cleverly disguised. Seems you were determined to grow, pregnancy or not.

I joined an online support group for adenomyosis and endometriosis and learned a lot about how women manage their pain and symptoms. There were mixed reviews about hysterectomies —  some reported regret, but most were thrilled with their decision. I saw photos of strong, brave women in gowns and surgical caps giving the thumbs up, their bright smiles and eyes saying “I’m so happy I’m out of surgery and am ready to live a pain-free life!” A lot of captions read, “I got this!”

As I continued to debate the merits of a hysterectomy, a turning point in our story forced a decision. I was put on blood thinners when I developed a deep vein thrombosis (DVT), and as much as I hated being on them, you really despised them. You refused to play well with them. That frowning cartoon uterus was probably now your permanent expression.

I ended up in the ER two months in a row with severe anemia from blood loss and needing blood transfusions. My doctor told me it was time to do the inevitable: your life or mine. So, during a global pandemic and the day after a heated presidential election, I had a full abdominal hysterectomy to remove you and your neighbors, my cervix and fallopian tubes.

Of course, I don’t miss my awful periods and not dealing with the monthly misery has been liberating. But here’s the bizarre thing: I think I miss you. It’s odd to feel this way since you caused me so much pain. But it saddens me to know the piece of me that I had dreamt would help me bear children no longer exists. My grief over this has overcome me at times and I feel a profound sense of loss. Where you used to be is now a place of inexplicable emptiness — physically yes, but also emotionally. When I look down at my belly, my six inch vertical scar is there reminding me of your absence, and what could have been. My dream of having a child, like you, is now only a memory.

I sometimes find myself wondering what happened to you. Did you end up in a laboratory getting dissected, or maybe thrown in a special bin for useless organs? Wherever you are, I imagine you as that pink, angry-faced cartoon, mad at me again, this time for dumping you.

One thing I’m sure of after all of this, however, is that not having you doesn’t make me feel less of a woman. I have read multiple stories about how a woman’s uterus can feel tied to her femininity, but I don’t think that way. I don’t need a uterus to give me an identity.

Aside from my online support group, I don’t know how other women feel about this topic — about how women view hysterectomy, their periods, miscarriage — really their entire reproductive life.  A woman’s uterus is the last thing anyone wants to talk about at a dinner party, understandably so. But in general, there should be less stigma around discussing the female body. I believe a lot of women deal with very similar issues privately and bringing you into more conversations could benefit a lot of people.

Anyway, my letter has gotten long so I better wrap this up.

I wish our time together didn’t end this way, but there’s so much we don’t get to choose in life. Things didn’t go the way either of us had hoped. I suppose we both got robbed — unable to complete our shared goal of a healthy, full-term pregnancy and childbirth. As time goes on, and I continue to heal — both physically and emotionally — I hope to find acceptance and peace in this next chapter of life without you.

Goodbye, Uterus.