Brief Answer:
withdrawal bleed is suggested...read details

Detailed Answer:
hello,
thanks for trusting health care magic.

considering your history given , it appears that your periods are regular and you had been oligo menorrhoeic for quite sometime with history of PCOS treatment and hypothyroidism with thyroxin. you have not mentioned about any history of OC pill intake or any low dose pills ( like ginette or deviry) for PCOS on going which is important to know.
with the concern of having missed periods and HPT negative i take it that you have not been on any contraception and neither you are contemplating/planning pregnancy.
now that the periods have been missed and HPT is negative and if your cycle is 35-45 days, then you can opt for a withdrawal bleed with progestins to resume your menses. but before that you need to undergo a pelvic ultrasound to ascertain the thickness of the endometrium. if its more than 8mm then progestins can be given for 5 days and periods should resume within 7-10 days from the last day of the progestin intake.
Also you complain of pelvic discomfort and dull pain on right side which appears to be constant and not associated with premenstrual syndrome symptoms, as ii decipher, in that case again an ultrasound pelvis can rule out any ovarian cyst which has enlarged to give you that dragging pain in the right iliac region on a constant basis.
your fibroids ( even 1.2 cm) are too small to cause period disruption . if they are subserosal , then no need to worry at all, if they are submucousal then the presentation would have been heavy and prolonged bleeding with episodes of spotting rather than oligomenorrhoea in your case. so it is interpreted that they are not disturbing the endometrium and most likely Intramural or subserosal.

with thyroid profile normal, i suggest you discuss the option of a withdrawal bleed with your gynae with progestins so that you can resume your menses and a definite ultrasound to rule out ovarian cyst and find endometrial thickness. after menses you need to keep a menstrual calendar for 3-6 months to chart your cycles and their future regularity. sometimes such isolated episode of delayed periods are due to high stress periods also when the cycle is deranged and delayed. so de-stressing exercises may be employed as well after the withdrawal bleed.

Thanks.
In case you have any further queries please feel free to contact me at:-
http://doctor.healthcaremagic.com/doctors/dr-sameer-kumar/68814

regards,
Dr.Sameer Kumar

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Brief Answer:
Ovarian cyst yes, but not endometriosis

Detailed Answer:
Hello,
Thanks for asking this, I was expecting this from your end.
The reason I didn't contemplate endometriosis or chronic pelvic pain as diagnosis is simply because the pain is a recent onset and not associated with menses which is contradictory for endometriosis. The pain is one sided or unilateral which excludes chronic pelvic pain as well which is bilateral.

So the prime suspicion remains ovarian cyst. Which if found on ultrasound, then you may have to undergo diagnostic laparoscopy and further the cyst may be removed laparoscopically with minimal access surgery and then you may be placed on low dose Oral contraceptive pills for at least 3 months thereupon.

For the pain presently, as I practice in my clinic I can suggest TAB MEFTAL SPAS 500 mg thrice a day with tab ranitidine 150 mg SR twice a day. But this may be please consulted with your treating gynecologist and you can get it prescribed through him/her.

Regards,
Dr.Sameer Kumar
Thanks. Any further query, you may feel free to contact me at:-
http://doctor.healthcaremagic.com/doctors/dr-sameer-kumar/68814

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