### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
hello I am a 24 year old female I got tubes tied 2 years ago and am I wondering what is the procedure or necessary steps when a cycle is late or missed. I am terrified of being pregnant again or having a ectopic pregnancy. If someone could assist I would appreciate. I have reached out to my doctors office but haven t yet received a response back.

### output:

Hi, I guess your concern is missed menses thereby ectopic pregnancy. Sometimes there will be menses irregularity after tubal ligation. This happens because the blood supply to the ovaries will be altered due to tube ligation. So the ovaries which are getting altered blood supply do altered/ irregular menses. The normal pattern of menses will resume slowly. So, don't worry. But there are the chances of ectopic pregnancy after tubal ligation. However, the chances depends on the type of surgery done for tubal ligation. As the type of surgery is not known, I can't comment on the chances of getting pregnancy or ectopic pregnancy. My advice:1. Wait for 4 to 5 days for menses to happen, if u still don't get menses go for a urinary pregnancy test. If it is negative we can wait for 5 to 6 days, if still no menses you have to revisit your treating doctor.2. If the urinary pregnancy test is positive, immediately visit your treating doctor. Usually a scan (ultrasound of abdomen and pelvis) to cross-check and confirm the ectopic pregnancy is done. If it is confirmed, your treating doctor will help you further. I hope this information is useful, informative and helpful.