What do you think, could i be pregnant?

Patient: I had a tubal ligation March of 2014. I am always regular even after my tubal done. 28-32 cycles. I had af May 13,2014, june 13, july 11, August 8 was suppose to come but it didn’t and I am now 14 days late all negative tests. I’ve tracked my periods for 3+ years on a tracker and is always right maybe give or take a day. It is now August 21 and no sign of my period. I went and seen a midwife nurse practitioner and she thought it was thyroids but she thinks its not that, so she checked my cervix and inserted a speculum and she couldn’t hardly see it at all but when she was able too it was super high and lots of watery cm. So she took a sample to test for Infection and after 15 mins the test came back negative for infection so that’s not what is making me miss my period. Then she did a exam with fingers and pressed on my uterus and ovaries to see if I have any cysts and I do not, so that’s not it either. She scheduled me a ultrasound on this Friday for stomach and a insert ultrasound to check ovaries and uterus. This is the very first time I have ever ever missed a period except when I was pregnant before with my other 3. I have never missed a period like this. Also on July 25th I ovulated had the pains and everything so that’s not it either. I have been having really sharp shooting pains in my lower abdomen above my pelvic bone and on the sides by ovaries specially the left side by ovaries. Im going stir crazy. I just want to know what you think, I am now 14 days late and cycle day 41 with no period and all negative pregnancy tests.

Doctor: Thank you for your question. The chances of becoming pregnant after a tubal ligation is very low, given the fact that yo u have had multiple negative pregnancy test and examinations by your nurse practitioner leads us to believe that the absence of your period, and lower abdominal pain could be due to another cause. Possible causes of these symptoms could be related to conditions of the ovaries such as polycystic ovarian syndrome, or due to a condition known as endometriosis. This occurs when endometrial tissue attaches and proliferates within the pelvic cavity outside of the uterus. Uterine fibroids can also result in delayed period and abdominal pain. Lastly, fluctuations in hormones, such as in hypothyroidism, or even early menopause can be a source for your symptoms.What is important is that you follow up with a gynaecologist who will perform a full pelvic examination, blood testing, and ultrasound to determine the cause of your symptoms. Although the chances of being pregnant are very low, the other possible causes could be serious and require immediate treatment. It is important that you promptly follow up with your doctor.Thank you for consulting AskTheDoctor.com