I’ve heard it said that it takes an average of seven attempts before a woman leaves. On the day I resolved to have my uterus removed, it had been such a long time coming that the decision was almost anti-climactic. I was on a long cross-country summer vacation bus trip with my kids, and what would have been a run-of-the-mill flooding (strange only for happening on day five of my eight-day period) cinched it for me. In the words of my people, b’eyan kan o yin mi, mo yinra mi! 

I had been patient. For years, bleeding out my life’s force in a repeated cycle that left no room for healing. I had endured physical pain, psychological torment, and the unnamed anxiety of what this uterus would throw at me next. I had worked hard, studied even harder, became a specialist in the process, and tried all the ‘conservative’ treatment options; much good it had done me! And as I attempted to clean myself in a cramped bathroom of a roadside SAPTCO bus stop, discarding the fist-sized clot of blood alongside an ineffectual sanitary product meant to contain it, thankful for the unrelenting black that saved my outer garment – at least – from a visibly crimson smearing, I knew I was done. It was time.

The first time I was offered a hysterectomy, I did not get to contemplate it. Too busy managing the reactions of others – husband, mother, siblings, even friends; everyone close enough to know had an opinion. Years later, in a similar professional position myself, I wondered what was going through the consultant’s mind when he made that suggestion. We had worked together for over a year by then, within the intimate confines of a small but busy maternity service. He knew my history, long before the fateful day I lost consciousness over a woman’s surgically opened abdomen, to become his patient myself. He, in this field of women’s bodies, surely realized what ruckus he was unleashing, suggesting that a not quite thirty-year-old, Nigerian Muslim mother-of-two have her womb removed just for some bleeding, severe anemia be damned!

An estimated eighty per cent of women will develop uterine fibroids by the age of fifty. Black women are up to five times more likely to do so, at an age up to ten years earlier, for reasons modern medicine is yet to clarify. Chronic stress, chemicals from hair relaxers, and genetic mutations are some of the possibilities so far floated. Depending on the size and location, one of the most common complaints from women with fibroids is heavy menstrual loss. Mine was a comparatively tiny 3cm growth that lodged itself under the lining of my womb, a notoriously difficult location to reach surgically, and proceeded to extort a bloody toll every twenty-four days. Outside of pregnancy, when I medicate with double-dose hematinics and maintain a carefully curated diet that never lasts beyond giving birth, I have been anemic my entire adult life. Constant fatigue, bothersome in a profession that demands hours of standing and regular twenty-four hour shifts, was my reality.

Growing up, no one prepared me for this. No one talked about women’s bodies, not openly, outside of allusions to illicit sex that women were always somehow responsible for. My earliest association with menstruation was the presence of a hut on the outskirts of the communal compound of my mother’s people, where women on their periods had to spend their nights. These women had to be out of the iga before sunset; they were not permitted in until daybreak, a socio-religious cultural norm maintained by widely known tales that hint at metaphysical penalties no one ever elucidated. 

To my single-digit-aged mind at the time, visiting from Lagos during school vacations, this was just another oddity of being in the village: an adventure. One which my cousin, two years older, unhindered by the peculiarities of a mother marrying outside the tribe and religion like mine had, liked to point out that I was excluded from. That exclusion bothered me, of course, in the way of little girls itching to be grown. But it never occurred to me to question why women on their periods needed to sleep in a single-room hut away from everyone else. The Muslim faith I was raised with had its own version of acts menstruating women were excluded from. I would also not examine the many fabled period-associated stories I picked up from plays and playmates of the time. At that age, you take your information where you could.

“You know how to use these, right?” had been the extent of any discussion with my mother. She’d thrust a couple of Simple cotton pads, distinct in their blue plastic cover long before Always became a thing, at my ten-year-old self. I, packing for my first venture into the adolescent jungle called a Nigerian Boarding school, hadn’t known any such thing. But this was one of those Yoruba-Mother questions that demanded an affirmative answer, or else. In any case, I was thoroughly schooled within the single term of hostel life before the first drops of (at that age) exhilarating yet terrifying red appeared a few months later. In hindsight, I marvel at the creativity of the stories we told ourselves, a testament to the information vacuum no one acknowledged. Of pain and shame, shrouded in silence and fear. It is what it is, we concluded as a collective, little girls referencing what a lifetime of lessons had taught us it meant to be women. 

I knew, even then, that missing class every First Day of Period on account of debilitating cramps, and routinely bleeding through clothing and bedding couldn’t possibly be good. But we are limited, as humans, to the life and circumstances our imagination can conjure. And it is remarkable what we will put up with when conditioned to accept it as “normal.” It would take the passage of time, proximity that precludes hiding and the occasional joint feminine lamentations to paint my family’s menstrual story. Ours is a lineage of wombs steeped in blood. Mother, sisters, aunts, and the odd ancestors we had access to – everyone had gory tales. Often with too much blood, pain, or growths that shouldn’t be, and babies that didn’t stay. We had more in common than not. To grow into womanhood is to be saddled with idealized histories and dreams you are taught you aspire to, and demanded you sacrifice for. 

When my daughter, at all of fourteen, asked me why I chose to have kids, my response was rueful in the way of the belatedly self-aware. I do not know that it was a conscious choice, much as that’s what was expected of people like us. In my pre-pandemic era, cosplaying as Well-adjusted Superwoman, I would never have admitted that. Because a “good woman”, the woman I tried to aspire to for an embarrassing majority of my life, does not rock the boat – even when that boat is so obviously sinking. But hysterectomy proved to be, unknown to me at the time, the beginning of the end of that sad costume party. 

Healing, slow and painstaking in the face of longstanding deficit, is in accepting that I am not the woman I once was. That I am not my mistakes, even as I admit them. That I do not have to perpetuate dysfunction to my and my loved ones’ detriment, for some arbitrary standard of good womanhood. That I can wake up, take stock and choose differently; it is never too late. Otherwise, what is that saying about insanity and repeating the same things? This stripped-down version of me is committed to an ongoing conversation with all of my children about decisions and choices and how choosing one(’s self) did not mean hating another. Sometimes, it is merely time to let go.

The accepted standard of medical care is typically: lifestyle modification, drug therapy, then procedures of increasing complexity and risks. When I made the appointment after that summer bus ride, I fully expected the run around. Even knowing that being on the receiving end of modern healthcare delivery is no less frustrating every time I had the displeasure, I booked at a hospital different from my workplace. I needed a surgeon who was not on my team, or so I thought, some veil for my physical and metaphorical nakedness on the altar of surgery. Accessibility barriers to Muslim women seeking healthcare are sometimes that covert. 

That first visit, I volunteered enough history to establish just cause, an “indication” in doctor-speak, and grit my teeth through the physical exams. As expected, I failed in my attempt to dissuade this male specialist of the female body from following “protocol” with the details of everything I had suffered and tried in the intervening years. I wondered at the chances of getting my way if I attempted to re-explain reproductive autonomy to this man. He with the harried “perpetually busy” air and an impressively wide range of asking the question, what if your husband wants more kids?  

I chose to pick my battles.

I would go back for almost half a dozen such, ultimately pointless, visits before I give up. This man would not give me what I want. Convinced he knew better, propped up by certificates and years of experience tinkering with bodies like mine and an institution that backs his opinion as more valuable – or at least more objective – than mine, he insists he cannot “justify going to such an extreme.” He followed painful tests with more tests, prescriptions I did not fill, with suggestions of procedures I was adamant I would no longer entertain. Pills, injections, burning the lining of the womb, even the “miracle” of the hormonal IUD; I had tried them all at some point over the intervening twelve years. Some helped for a while, until they didn’t. Some brought on side effects worse than the ailment. The IUCD spontaneously extruded, swaddled in clots, twice – and yes, that felt as horrible as it sounded. But attempting to reason with a man determined to see women as functional reproductive units is one of life’s most infuriating experiences. I left the last appointment with my file tucked under the billows of my abaya.

Two months later, on a “slow” Friday afternoon, my boss (a different man in a different country, several bosses removed from the one who made the initial suggestion) performed my hysterectomy. He, too, had attempted a half-hearted correction – of the anemia, at least. When, like I’d predicted, blood work done after my last ever menses showed that the meager gains of his iron infusion regimen had drained out with the flow, he capitulated. I went into surgery alone, starting pre-op at the tail end of my last shift in that hospital, four pints of blood on standby for any eventuality. Everyone who needed to know was several streets and continents away, informed via text just before or immediately after the procedure; I was otherwise preoccupied to register any reactions. In a post anesthesia pain med haze, the only explanation I gave was to my kids: what happened, why it was necessary. The alarm in their gaze – they had only ever known Ummu, and their mum was not this vulnerable person laid out in frailty – was not muted as I tried to reassure them. All will be well now, you’ll see. I will be well soon. 

Three years on, my hysterectomy scar is nearly invisible, buried under the belly grown from months of post operative care that precluded my exercise routine, and my ongoing post-pandemic disenchantment with productivity. I have kept details of my surgery largely private, not for shame, nor for fear of judgment. I do not harbor any regrets – hysterectomy belly and persistent hypertension notwithstanding. I do not miss the cramping, the flooding, the lightheadedness when I move too suddenly. Finally free of the near-crushing anxiety many women live with – of becoming one of the 1-2 per thousand women-years failure rates of whatever contraceptive currently being used – I do not feel any less ‘woman’!

This feeling is more complex, less easily defined. We’d been through a lot, my uterus and I. The many dreams of womanhood – realized or not – and the three little humans we bore. For all of the pain, there had been beauty, too. Ours is a bond never meant to be severed, and it does not hurt less for being the one who walked away. This is a lingering sense of something akin to loss, a phantom pain unspoken. And while I tell myself that I have healed, there are minor inconveniences to this. I can never again hit the snooze button on my fajr alarm; I no longer have the exemption that my periods offer from getting up at dawn to pray, some days of each month. Other days, I’m left trying to figure out if that particular day’s “if I lay here…”  blues is courtesy of PMS, or a relic of the depression that checks in once in a while, years after being clinically deemed no longer in need. 

Then there are days with major existential angst that makes you doubt. Ibere ko lonise; is it patience if you eventually quit?  And what does it say about you that you waited so long, endured so much? Like much of Life itself, I suspect there are as many answers there as there are questions, which is to say, there might not be any answers. Sure, I could have held on for the next decade or so. Nature would have eventually taken its course – hormonal regression following menopause results in the shrinking of most fibroids. And in both of my cultures, women who stay (for too many reasons) are the venerated ‘good women’. Patience, if its pursuit did not kill them, with societal anecdotes tell them that the torment would stop. Eventually. Someday. Assailants get bored, or leave, or find someone else to torment, or grow too old and ineffectual in causing harm.

That brand of goodness, I’ve learnt, comes at a price I am unwilling to pay. Like one distraught husband in my consulting room who refused to believe that there wasn’t a gaping hole at the end of his wife’s post-hysterectomy vagina waiting to swallow his penis, sometimes we make our own truth. And everyone will ultimately find their way to come to terms with what is. The womb is gone and the woman is (still t)here, hopefully stronger for having survived. This is why I choose to model this for my daughters, that women know to say “enough.” It is how I prepare my daughters. The nine-year-old, an unplanned gift of the years between diagnosis and definitive treatment, is learning what her body is capable of, the joys and pains a womb can birth and wreck. She, bright-eyed and eager to be ‘woman’, remains enthralled by the stories and legacies of maternal and menstrual ancestresses from a village of communal compounds and small, solitary ‘period’ huts.

About the Author:

Muti’ah Badruddeen is a Nigerian health worker and homeschooling mum who writes mostly contemporary women’s fiction. For her debut novel, Rekiya&Z, she was a finalist at the 2022 TLC UK Pen Factor competition, and a 2022 winner of the SprinNG Women Author Prize in Nigeria. Her work has appeared in Brittle Paper, The Shallow Tales Review, The Drabble, Overtly Lit among others.When she is not juggling her many balls of life, Muti’ah can be found catching up on her sleep. She’s on Twitter and Instagram as @/deenprogress.

*Feature image by Oscar Keys on Unsplash