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Estrogen patch and flare up after hysterectomy

Hello I am 52 I had excision surgery and was diagnosed with stage 4 Later i had a partial hysterectomy and was told that my intestines and ovary were stuck to my abdomen and that was fixed I was better for a few years but symptoms are progressively worsening I start hrt about a year ago for menopause symptoms I am always confused if pain is endo or bowel issues or both. Seeking guidance

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Dr Justine Roper DPT

Thank you for sharing your story. I want to start by saying you’re not alone in feeling confused or overwhelmed by what you’re experiencing. As a pelvic floor therapist, I see many clients navigating similar journeys with endometriosis, menopause, bowel concerns, and post-surgical changes. Here’s a breakdown of what may be happening and how pelvic floor therapy can support you:

1. Understanding the OverlapEndometriosis, especially at stage 4, can lead to dense adhesions (scar tissue) that bind organs together — like the ovary and intestines in your case. These adhesions can persist or reform after surgery, sometimes causing:

  • Deep pelvic or abdominal pain
  • Bowel discomfort (especially with constipation, bloating, or during bowel movements)
  • Pain with movement, sitting, or even intimacy

HRT can help ease some symptoms related to hormonal shifts but doesn’t directly address structural or mechanical pain from scar tissue, nerve sensitization, or pelvic floor dysfunction — which often gets overlooked.

2. Pelvic Floor Dysfunction Post-SurgeryAfter multiple surgeries and hormonal changes, the pelvic floor muscles can become:

  • Overactive (tight or guarded)
  • Underactive (weak or uncoordinated)
  • Or both — contributing to symptoms like pelvic pressure, incomplete emptying, or pain that mimics endo or bowel issues

Many people also unknowingly “brace” or hold tension in their abdomen/pelvic floor when dealing with chronic pain — which can perpetuate the cycle.

3. Why You Might Feel Both Endo and Bowel PainThe intestines and pelvic organs share nerve pathways, so it can be hard to pinpoint exactly what’s causing what. This is called viscero-somatic convergence, and it means that pain from one organ can be felt as pain in another area. A pelvic floor PT trained in visceral work (gentle mobilization of internal organs) and scar tissue release can help discern and relieve these patterns.
What You Can Do:

  • Schedule a pelvic floor therapy evaluation with someone who understands complex pelvic pain and post-surgical care. They’ll assess your breathing patterns, muscle function, scar mobility, and visceral mobility.
  • Track your symptoms — note what worsens or relieves the pain (food, stress, position, movement).
  • Talk with a GI or pelvic pain specialist — because collaboration across disciplines is key here.
  • Be gentle with yourself. Your body has been through a lot. Healing is possible.
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Jill Ingenito, DO

Thank you so much for opening up and sharing your story. You’ve been through so much, and it makes perfect sense to feel unsure whether your pain is coming from endometriosis, your bowels, or a mix of both—especially after major surgeries like excision and hysterectomy.

One very important point I want to highlight:
If you have a history of endometriosis, estrogen should never be taken alone—even after a hysterectomy. It must be paired with progesterone. Estrogen on its own can stimulate any remaining endometriosis tissue and cause flares, even if your uterus has been removed. This could absolutely be contributing to your worsening symptoms over the past year since starting HRT.

Many patients with deep disease or bowel involvement continue to have pain due to scar tissue, adhesions, nerve involvement, or even overlapping pelvic floor dysfunction. Bowel symptoms and endo pain often look alike, so it’s not unusual to feel confused or frustrated trying to sort them out.

A few steps you might consider:

  • Talk to your provider about adjusting your HRT—adding progesterone if you’re not already on it, or trying a different delivery method.
  • Consider evaluation by a GI specialist and/or imaging to assess bowel involvement.
  • Look into pelvic floor physical therapy, which can be a game-changer for patients with chronic pelvic or bowel-related pain.
  • A pain management or endo specialist might explore nerve-related sources or central sensitization as well.
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