14/09/2026
“Doc, my ultrasound only shows myomas. So why does it hurt this much?”😣😖
For several years, this patient had chronic pelvic pain that didn’t quite match her ultrasound findings. The myomas weren’t large enough to explain the severity of her symptoms, and medications weren’t helping enough. Eventually, she came to me already decided:
She wanted a hysterectomy.
But sometimes, when the story doesn’t make sense on paper, you have to look beyond the paper.
And when we looked inside…
Severe deep infiltrating endometriosis.👹
Extensive fibrosis. Dense adhesions. Endometriotic nodules. Distorted anatomy. Bleeders that were difficult to reach because everything was stuck together.😵💫
So we proceeded with hysterectomy, endometriosis excision and extensive adhesiolysis—and ultimately, hypogastric artery ligation to control bleeding safely.
Because, yes, endometriosis can be unpredictable.
You don’t always know what you’ll find until you look.
When the pelvis decides to surprise you…
Don’t panic. We have a plan… and a backup plan… and another backup plan.
Complex pelvic surgery isn't just about knowing how to operate.
It’s about anticipating what might be waiting inside, recognizing distorted anatomy, knowing when the usual approach isn’t enough, and having a safe strategy for the unexpected.
This is why chronic pelvic pain deserves to be listened to.
Endometriosis can be subtle. It can hide. And sometimes, if you don’t go looking for it, it will not show itself.
And the most important message on this case?
Listen to the patient. Look at the whole clinical picture.
Treat the patient, not the imaging results.
Pain is real even when the scan looks “normal.”
And sometimes, the most important clue isn't on the ultrasound.
It’s the patient sitting in front of you saying, “Doc, something is not right.”
Minimally Invasive and Advanced Gyne Surgery (MIAGS) Team
🏥 Ortigas Hospital and Healthcare Center
ObGYN/MIAGS Surgeon: Jane Ellise Javier, MD
Anesthesiologist: Dr Marilet Caluag
Assist/OB Jcon: Dr Jam Regio
🙌
📸 Photos and Story posted with permission AND per patient's request. Thank you so much for the trust and sharing your story with us, Ma'am Melanie. 😊❤️