Hello, I am having symptoms of pain with bowel movements since 2022. I thought that I had problems with my colon and hemorrhoids. I asked my JP for a referral for a gynecologist, but after so many years, nobody helped. I also have pain in my deep rectum area since I gave birth to my son in 2017. Since 2022, very heavy painful periods. In February 2025, in my country, I was finally diagnosed by an endometriosis specialist with deep endometriosis stuck to the back of my uterus and bowel. I have tried Dienogest for 4 months, and I had side effects such as migraine and hot flushes. Then I tried the combined contraceptive pill and I had extremely painful menstruation, and I stopped it. Now I have inserted the Mirena IUD a month ago, and I have had spotting all month, plus pain with bowel movements on my menstrual days now. I am 44 years old, and doctors suggested a full hysterectomy and bowel resection because an MRI showed adenomyosis as well. My thoughts are, is it the right time to do a bowel resection, or should I wait 2 months more to see if Mirena will help improve bowel symptoms, and should I remove my uterus because the last couple months since I start be more active and take some supplements such as NAC, omega 3 my period became lighter and less painful, just without any hormonal treatments and now with Mirenan, is more painful both period and bowel. Thanks in advance for your advice!
Endometriosis
Endometriosis in College: How to Take Care of Yourself When Life Doesn’t Pause
College is challenging enough when you’re healthy – throw endometriosis into the mix, and it can feel downright impossible some days. Classes, exams, and the
December 23, 2024
Thank you for sharing your history with me. I can imagine how frustrating and exhausting it must have been to go through years of pain and uncertainty before finally receiving a diagnosis. What you describe — pain with bowel movements, heavy and painful periods, and MRI findings of deep endometriosis and adenomyosis — are consistent with what many women experience when endometriosis affects both the uterus and the bowel.
From an evidence-based perspective, international guidelines such as those from the European Society of Human Reproduction and Embryology (ESHRE) and the American College of Obstetricians and Gynecologists (ACOG) recommend that treatment decisions should always take into account three main factors:
You have already tried several hormonal options (Dienogest, contraceptive pills, Mirena IUD), and unfortunately they have not given you adequate relief, or they caused significant side effects. This is important information because guidelines suggest surgery is often considered when medical treatments are not effective or not tolerated.
Regarding your specific questions:
In summary, your situation is complex but not uncommon. Surgery — including hysterectomy and treatment of endometriosis with bowel resection — is a reasonable option when quality of life is significantly affected and medical therapies have failed. That said, the decision should always be individualized, based on a careful review of your MRI, symptoms, and personal priorities.
If you feel your pain is manageable and your quality of life acceptable, it is reasonable to wait a short time longer to see if Mirena helps. If your pain remains disabling, moving forward with surgery may bring the best chance of long-term relief.
Please remember: you deserve to be heard and to have a plan tailored to you. Seeking a second opinion, as you are doing now, is exactly the right approach.
With empathy and best wishes,
Patrick Bellelis, MD PhD.