My cycles are around 38 days. I spot for four to seven days before I actually start my period. My doctor said the spotting is just because I have a longer cycle than normal. Is either the long cycle or the spotting indicative of a problem? We have been trying to conceive for two years now.

G.R.

Spotting before the start of a period is not an unusual situation. We can only guess at the cause for this condition. Spotting before the period has been reported in women suffering from endometriosis. But while an association with endometriosis exists, it is not clear how endometriosis would cause spotting. While spotting is not in itself an indicator that you would have fertility problem, if you have painful periods, diarrhea or urinary frequency around the time of your menses and often have painful intercourse, you may have reason to suspect endometriosis, and you may need a laparoscopy to make the diagnosis and ensure that your fallopian tubes are normal.

Your long periods are of more concern. Normal menstrual cycle length varies between 25 and 35 days. As such, 38-day periods are longer than normal and deserve evaluation. Your doctor may wish to order tests for thyroid function (TSH) and pituitary function (prolactin), both of which can influence cycle length. If your physician suspects polycystic ovary syndrome (PCOS), he or she should check your levels of androgens (male hormones) such as DHEAS and testosterone are measured. Your medical history may provide clues, as may your age, recent weight changes, exercise habits and stress levels.

Infertility is diagnosed after you have been unable to achieve pregnancy for one year. At that point, it is appropriate to initiate an infertility evaluation. Since you have been trying to conceive for two years, there is no time like the present to discuss with your doctor the steps involved in this evaluation.