A painful health condition on the rise in young women - and a radical treatment option - prevented Dolly Parton from becoming a mother.
The country music icon passed away Tuesday at 80 years old following a brief battle with cancer, her representatives have confirmed.
She is survived by six siblings and a large extended family of nieces and nephews, but the 9 to 5 hitmaker never had children of her own.
More than four decades ago, Parton announced she had been diagnosed with endometriosis, a debilitating reproductive condition that causes tissues similar to those found in a woman's uterus to grow elsewhere in the body.
This excess tissue causes excruciatingly painful periods, excess bleeding and, for up to half of those with the condition, infertility.
Leading up to her diagnosis in 1982, at age 36, Parton described having to cancel a major tour due to severe abdominal and pelvic pain, as well as hemorrhaging. She also struggled with digestive distress.
In 1984, the singer underwent a partial hysterectomy to remove her uterus - which may help alleviate some endometriosis symptoms - stopping menstruation. However, this meant she would never be able to become pregnant and have her own children.
'I can't have children physically,' she told Gloria Steinem in 1987. 'I love children. I don't know that it also wasn't God's will, you know, for me not to have kids.
Legendary country music star Dolly Parton, who died this week at age 80, was open about her experience with endometriosis and infertility. She is pictured above in 2018
In 1984, the singer underwent a partial hysterectomy to remove her uterus - which may help alleviate some endometriosis symptoms. Parton is pictured above circa 1981
'I mean, I try to look at things in a way that I can put them in a proper place because somebody has to be out there doing something to entertain other people’s children.'
The CDC estimates between six and ten percent of reproductive-aged women in the US have endometriosis, with it most commonly being diagnosed in those ages 15 to 24 and 35 to 49.
And about 25 to 50 percent of those suffer from infertility due to damage to the pelvic organs and procedures such as hysterectomies to reduce symptoms.
In endometriosis, endometrial tissue, which lines the inside of the uterus, grows in other areas of the body such as the ovaries, fallopian tubes, bowels and bladder.
During a woman's menstrual cycle, endometrial tissue acts similarly to the lining of the uterus, thickening and bleeding.
This misplaced tissue has no way of leaving the body, leading to scar tissue called adhesions.
Adhesions cause the pelvic organs to stick together or become fused, forming cysts and obstructions. Scar tissue can also block the fallopian tubes, making it difficult for egg and sperm to meet during reproduction, making it impossible to conceive.
Dolly Parton speaks to children at the launch of her Imagination Library book project at the Magna Centre in Sheffield, England in 2007
The most common symptoms are extremely painful menstrual cramps, heavy bleeding during periods, abdominal and back pain, pain during sex and digestive issues such as diarrhea, constipation and bloating.
People with a family history of endometriosis, as well as those with longer periods and who have never given birth are at an increased risk, which experts believe is due to them continuously being exposed to estrogen that fuels endometrial tissue growth.
Endometriosis is also on the rise in the US, with recent Epic Research data showing a 32 to 42 percent increase in diagnoses between 2017 and 2024. The largest increase – 44 percent – was in women over 49.
Clinicians have noted this is likely due to increased awareness, along with more advanced pelvic ultrasound and MRI scans becoming more common.
Doctors may prescribe hormonal birth control such as the pill or an intrauterine device to regulate hormone levels and stop or ease menstruation before opting for a hysterectomy in more severe cases.
