Pelvic Pain and PCOS: Understanding Provera & Ovarian Cysts

Question
Dr. Rappaport,

I am a 25 y.o. G2P2 and was diagnosed with PCOS after the birth of my first child.  I haven't had a period since January 26th of this year and have had several negative pregnancy tests including a negative serum HCG last week.  I am experiencing a lot of pelvic pain.  I had a trans-vag ultrasound last week and the tech said there was a rather large hemorhhagic cyst on my left ovary.  There is also a question of endometriosis.  My doctor also prescribed Provera to induce a period, and it didn't work.  I never got my period.  I took it for 7 days and it is the 14 day since I finished it.  What do you think the next step is?  Do you think I should opt for laproscopy?  Thanks for your help.

Answer
Ask the sonographer how large the hemorrhagic cyst measured. If the cyst is less than 5cm in diameter, nothing need be done except some analgesics to control the pain. However, if the cyst measures over 6cm in diameter, it should be removed. If both urine and blood tests were negative for pregnancy, I doubt that you are pregnant. I would also take another course of  Provera to try to induce your cycle. If you decide to remove the hemorrhagic cyst, it can be removed via laparoscopy deoebdubg ib giw big it is.