Hello, and I hope I can help you today. First of all, if you were sterilized, there is no reason to suspect that any symptoms you may be experiencing are caused by pregnancy. Fewer than one in 10,000 women will get pregnant after tubal ligation in their lifetime. The most common sign of pregnancy is missing your menstrual period. If you got your period on time and it was normal for you, there is no reason to suspect that you are pregnant. Pregnancy symptoms vary widely between women, and many of the symptoms that we commonly associate with pregnancy like bloating, breast tenderness, spotting, mood changes, and nausea can be caused by hormonal fluctuations as well as pregnancy. However, in women who do get pregnant after having a tubal ligation, there is a high risk of the pregnancy actually occurring within the fallopian tube, called an ectopic pregnancy. If you do find out that you are pregnant after tubal ligation, it is important to seek medical care right away, as an ectopic pregnancy can be an emergency requiring surgery for treatment. Having severe abdominal pain is not normal even if you are not pregnant. For example, appendicitis can cause severe abdominal pain and nausea and kidney infections can also cause abdominal and back pain. Any woman can have spotting when the body is under stress from other illnesses. I do recommend that in your situation that you should seek medical care urgently for an evaluation. Even though it is unlikely, performing a pregnancy test may be a good idea because if you are pregnant, you should be seen in an emergency room to make sure that your symptoms are not caused by an ectopic pregnancy. It may be prudent for you to go to an emergency room anyway, as other severe illnesses that require hospitalization, such as appendicitis and kidney infections can also be causing symptoms such as yours. I hope that I was able to adequately answer your question today, and I hope you seek medical care promptly and get an accurate diagnosis of your symptoms. Best wishes, Dr. Brown