In a first-person essay featured in the March issue of Vogue, the 31-year-old Girls star and creator writes that she made the tough decision to have her uterus and cervix removed after a decade of battling pain from endometriosis and nine previous surgical procedures.

Dunham writes that the pain had become “unbearable” in August and after trying “pelvic-floor therapy, massage therapy, pain therapy, color therapy, acupuncture, yoga,” she checked herself into the hospital and announced, “I am not leaving until they stop this pain or take my uterus.”

She writes that doctors then spent the next 12 days ensuring that her decision to have the procedure was final.  Once out of surgery, Dunham learned about the true physical state of her uterus and other reproductive organs.

“I wake up surrounded by family and doctors eager to tell me I was right. My uterus is worse than anyone could have imagined,” she writes, before detailing a litany of medical issues.

She adds, “The only beautiful detail is that the organ — which is meant to be shaped like a lightbulb — was shaped like a heart.”

According to the Mayo Clinic, endometriosis can result in “severe” pain and fertility problems due to tissue that grows outside the uterus instead of inside, which is normal in most women.

In her essay, Dunham states that she’s still determined to have children.

“I may have felt choiceless before, but I know I have choices now,” writes Dunham, who recently split from longtime boyfriend Jack Antonoff. “Soon I’ll start exploring whether my ovaries…have eggs.”

If not, she adds, “Adoption is a thrilling truth I’ll pursue with all my might.”

The March issue of Vogue is out February 20.