<s>[INST] I am 45 years old and had a pregnancy 21 years after a tubal ligation that ended in miscarriage in Dec. 2009, an ectopic 6 months after that which my doctor advised to have my left ovary (due to cysts ) and both tubes removed in May 2010. I now have not had a period since Jan. 10th...have had mild pregnancy symptoms and my lower abdomen is hard. Home preganacy tests and qualitative hcg tests came back negative. My hormone and thyroid levels have been checked and are normal, as were the luteal phase so he says I m not in perimenopause. I m very concerned that I could have an ectopic, but am wondering the chances of that happening. [/INST] Hi, In the current scenario, I would advise you to go for a trans-vaginal sonogram to exclude any local causes for the amenorrhoea. If you are not pregnant, and as your hormonal profile is normal, then the cause for the delayed period could be inadequate ovarian function as you have only one ovary left and owing to your age, the ovarian reserve of your other ovary is also likely to be less. Please maintain a healthy weight and a healthy diet and do some regular exercise. Good luck. </s>