What are the next diagnostic and management steps for a patient experiencing a two-month delay in menstruation, a lack of withdrawal bleeding after a 5-day course of medroxyprogesterone acetate (Deviry 10 mg), pelvic ultrasound findings of an 8 mm endometrial thickness and a 43x33 mm thin-walled clear right ovarian cyst, and symptoms of mild back pain, pelvic cramping, and brown discharge?
A 43 mm thin-walled clear cyst is very common, typically benign, and often resolves on its own. Your mild symptoms and brown discharge are likely related to this hormonal imbalance. Since you did not experience withdrawal bleeding after medroxyprogesterone acetate (Deviry), the next steps should include a pregnancy test to rule that out, followed by blood tests to check hormone levels (like thyroid, prolactin, or estrogen). Your doctor will likely recommend a repeat ultrasound in 6 to 8 weeks to monitor the cyst. Please share these results with your gynecologist to discuss the best path forward.