I am 44 years old, had a tubal ligation 14 years ago. For the first time ever, I was over two weeks late getting my period. When it finally showed, I have extreme pain, especially in lower left pelvic region...throbbing feeling from the inside. However, the bleeding is not near as heavy as my normal periods have been. I have had ruptured cysts in past, and know that they found a small one during an ultrsound a few months ago. Is it possible that this has ruptured and would it cause this much pain? Should I be concerned?