Lena Dunham has never shied away from discussing her body. Frequent nudity earned “Girls” its reputation as one of the most thinkpieced-about shows on television, and protagonist Hannah Horvath’s frequent proclamations of body acceptance mirrored Dunham’s own. She has spoken at length about her struggle with endometriosis, even posting on Instagram about it.

The writer-actress disclosed in an essay published Wednesday by Vogue that she had recently undergone a hysterectomy, her ninth surgical procedure after a decade-long battle with the disorder. Endometriosis causes tissue that ordinarily grows inside the uterus to grow outside  the organ, and it debilitated Dunham. She said she decided to have the procedure after her other surgeries and coping mechanisms failed to alleviate the pain.

“Because I had to work so hard to have my pain acknowledged, there was no time to feel fear or grief. To say goodbye,” she wrote. “I made a choice that never was a choice for me, yet mourning feels like a luxury I don’t have. I weep, big stupid sobs, alone in the bathtub or in the area where, in a terribly cliche turn, I have started crafting.”

Dunham, who is 31, mourns her inability to carry a child, a question she previously swatted away in an essay published in October. “For many, motherhood is seen as the pinnacle of a woman’s life — and I (sometimes) get the sense that concern about whether I can pop children out supersedes any sense of empathy about how my symptoms are affecting my life on a daily basis,” she wrote.

In the Vogue piece, Dunham recalls subconsciously stroking a prosthetic belly worn throughout Hannah’s pregnancy on the last season of “Girls.” While her character grappled with the pressures of impending motherhood, the actress wondered whether carrying her own child would even be a possibility for her. Dunham said she “never had a single doubt about having children” and even pretended to be pregnant in her youth by stuffing her shirt with fresh laundry. The show wrapped in April with an episode focused entirely on Hannah’s early parenting days, and Dunham underwent the hysterectomy months later.

“Sonograms and Instagram feeds don’t break my heart like they did when I still had a uterus that didn’t work,” she wrote. “The children who could have been mine do break my heart, and I walk with them, with the lost possibility, a somber and wobbly walk as I regain my center.”

Dunham’s revealing essay echoes two written by Angelina Jolie in 2013 and 2015, both published by the New York Times. In the first, titled “My Medical Choice,” the actress shared her decision to have a preventive double mastectomy after learning of a mutation in the BRCA1 gene, which led to a heightened risk of breast and ovarian cancer. Jolie had lost her mother, grandmother and aunt to cancer, and by outlining the exact procedure, she said, she hoped to inspire others with a family history of the disease to seek out information, too.

“I wanted to write this to tell other women that the decision to have a mastectomy was not easy,” Jolie wrote. “But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer.”

Jolie followed up two years later with a detailed op-ed about the preventive removal of her ovaries and fallopian tubes.

“I feel deeply for women for whom this moment comes very early in life, before they have had their children,” she wrote. “Their situation is far harder than mine . . . . It is not easy to make these decisions. But it is possible to take control and tackle head-on any health issue. You can seek advice, learn about the options and make choices that are right for you. Knowledge is power.”

Celebrities have increasingly been open about their reproductive health in recent years. Model Chrissy Teigen, currently pregnant with her second child, described her experience with in vitro fertilization to Self magazine in 2016: “Emotionally, it could be really hard. When you have these high-highs and low-lows, and you’re, like, cuckoo pants.” Her close friend Kim Kardashian West has written about having early-onset preeclampsia and placenta accreta, a high-risk condition in which the placenta grows deeply into the uterine wall, while delivering her daughter North. Others such as Gwyneth Paltrow and Adele have publicly discussed their postpartum depression, and Hayden Panettiere entered a treatment center in 2015 to battle the condition.

“It’s something that needs to be talked about,” Panettiere said during a television appearance that year. “Women need to know that they’re not alone and that it does heal.”

Dunham ended her Vogue essay by reflecting on the choices that do remain for her. She wanted to experience “what nine months of complete togetherness could feel like,” but adoption is a “thrilling truth I’ll pursue with all my might.”

“I was meant for the job, but I didn’t pass the interview,” Dunham wrote. “And that’s okay. It really is. I might not believe it now, but I will soon enough. And all that will be left is my story and my scars, which are already faded enough that they’re hard to find.”

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