While several stars have opened up about their struggles with reproductive health and endometriosis, few (if any) have given as raw and candid a look at their journey as actress and writer Lena Dunham.

Though the Girls star underwent a hysterectomy (the removal of her uterus) at the end of last year, her endometriosis-related pain has persisted, ultimately causing her to have her left ovary removed on Tuesday.

In a brutally honest Instagram essay, Dunham shared a photo of her surgery scars, writing about her procedure and the misconceptions surrounding her disease, and clarifying how thankful she is for her access to health care.

Today - Season 67
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“A big lesson I’ve learned in all this is that health, like most things, isn’t linear- things improve and things falter and you start living off only cranberry juice from a sippy cup/sleeping on a glorified heating pad but you’re also happier than you’ve been in years," she wrote.

"I feel blessed creatively and tickled by my new and improved bellybutton and so so so lucky to have health insurance as well as money for care that is off my plan. But I’m simultaneously shocked by what my body is and isn’t doing for me and red with rage that access to medical care is a privilege and not a right in this country and that women have to work extra hard just to prove what we already know about our own bodies and what we need to be well. It’s humiliating."

Using her own story as a call to action, she continued, "My health not being a given has paid spiritual dividends I could never have predicted and it’s opened me up in wild ways and it’s given me a mission: to advocate for those of us who live at the cross section of physical and physic pain, to remind women that our stories don’t have to look one way, our pain is our gain and oh shit scars and mesh “panties” are the fucking jam. Join me, won’t you?”

Dunham is notoriously outspoken on social media. She was met with praise over the summer when she shared a side-by-side photo of herself at her thinnest and at her current weight, explaining that she’s much happier at 162 lbs than she was at 138 lbs.

We thank you for your honesty, Lena.