NAMs Menopause Certification Exam
questions and verified answers (
detailed & elaborated) ACTUAL EXAM
2026 TEST!!
Climacteric phase - CORRECT ANSWERS The period of endocrinologic, somatic, and
transitory psychologic changes that occur around the time of menopause.
Early menopause - CORRECT ANSWERS LMP before age 45.
Late menopause - CORRECT ANSWERS LMP after age 54.
Primary ovarian insufficiency - CORRECT ANSWERS Menopause that occurs before age
40.
Early menopause transition (stage -2) - CORRECT ANSWERS Persistent difference of 7
days or more in the length of consecutive cycles.
Late menopause transition (stage -1) - CORRECT ANSWERS 60 or more consecutive days
of amenorrhea.
Luteal out of phase event (LOOP) - CORRECT ANSWERS Explains why some
perimenopausal women have elevated estrogen levels sometimes.
Obese women and estradiol levels during menopause - CORRECT ANSWERS Obese
women are more likely to have anovulatory cycles with high estradiol levels.
Chinese and Japanese women - CORRECT ANSWERS These ethnic groups have lower
estradiol levels than white, black, and Hispanic women.
Stage +2 - CORRECT ANSWERS Late menopause stage: 5-8 years after FMP. Somatic
aging predominates.
Stages +1a, +1b, +1c - CORRECT ANSWERS Early post menopause: 2 years after FMP.
FSH rises, estradiol decreases.
Elevated FSH, LH - CORRECT ANSWERS Endocrine labs after menopause.
AMH, inhibin B - CORRECT ANSWERS These hormones work during reproductive years
to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms - CORRECT ANSWERS
Menstrual cycle variable, persistent >7 day difference between difference in length of consecutive
cycles.
,How to respond if a patient requests FSH lab? - CORRECT ANSWERS Many pitfalls,
variable depending on the day of the cycle you draw the lab.
The potentially superior marker of menopause, a lab. - CORRECT ANSWERS AMH.
DHEA (dehydroepiandrosterone) - CORRECT ANSWERS Adrenal androgens: precursor
hormones produced by the adrenal gland that are enzymatically converted to active androgens or
estrogens in peripheral tissues.
Location of estrogen receptors - CORRECT ANSWERS Vagina, vulva, urethra, trigone of
the bladder.
Effects of estrogen on tissue - CORRECT ANSWERS Maintain blood flow, the collagen,
and HA within the epithelial surfaces.
Vaginal changes with menopause - CORRECT ANSWERS Thinning, loss of elasticity, loss
or absence of rugae.
Vagina and urethra in menopause - CORRECT ANSWERS Vagina narrows, urethra moves
closer to the introitus.
Stress urinary incontinence - CORRECT ANSWERS Vaginal estrogen and urinary
incontinence: what type does it help with?
Treatment for FPHL - CORRECT ANSWERS Minoxidil, spironolactone, finasteride,
estrogen therapy.
Late reproductive years -3b and -3a - CORRECT ANSWERS -3b: menstrual cycles normal,
FSH normal, AMH low, AFC low, inhibin low. -3a: subtle menstrual changes, variable FSH, AMH low,
AFC low, inhibin low.
When it is appropriate to check an FSH during the cycle if you check it? - CORRECT ANSWERS
Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
AFC - CORRECT ANSWERS Antral follicle count. Number of follicles that are detectable
with ultrasound.
Late menopause transition (-1) FSH level on random draw - CORRECT ANSWERS 25 or
higher.
Black women have higher or lower FSH levels? - CORRECT ANSWERS Higher.
Chinese and Japanese women have higher or lower estradiol levels compared to white, black and
Hispanic women? - CORRECT ANSWERS Lower.
Menopause transition-changes in SHBG and testosterone? - CORRECT ANSWERS SHBG
decreases. Testosterone/SHBG ratio increases by 80%.
, Testosterone/SHBG ratio is called what? - CORRECT ANSWERS The free androgen index.
What stage are VMS more likely? - CORRECT ANSWERS +1b (generally last 2 years).
What hormone is generally higher in obese women? - CORRECT ANSWERS Estrone-via
aromatization.
The postmenopausal ovary continues to produce what two hormones? - CORRECT ANSWERS
Testosterone and androstenedione.
Surgical menopause causes women to have lower levels of what hormone? - CORRECT ANSWERS
Testosterone. 40-50% lower than in women w/ intact ovaries.
Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B and
AMH? - CORRECT ANSWERS Inhibin and AMH decrease.
In the menopause transition, women spend more time in what phase? - CORRECT ANSWERS
Luteal-more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition - CORRECT ANSWERS It is felt that the
HPO axis may become less sensitive to estrogen.
In the first year after the FMP, there is no production of what hormone? - CORRECT ANSWERS
Progesterone.
What region of the adrenal gland secretes the androgens? - CORRECT ANSWERS Zona
reticularis.
What are considered the 'adrenal androgens'? - CORRECT ANSWERS DHEA, DHEAS,
Androstenedione.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors.
- CORRECT ANSWERS Angiotensin II, potassium concentration, adrenocorticotropic
hormone secreted by the anterior pituitary.
What part of the pituitary gland secretes adrenocorticotropic hormone? - CORRECT ANSWERS
Anterior pituitary.
Cortisol and HRT - CORRECT ANSWERS Most serum cortisol circulates bound to cortisol
binding globulin.
Do cortisol levels associate with VMS severity? - CORRECT ANSWERS No, cortisol levels
have NOT been associated with more severe VMS.
Local DHEA has been proven to help with what? - CORRECT ANSWERS Vaginal pain and
dyspareunia.
questions and verified answers (
detailed & elaborated) ACTUAL EXAM
2026 TEST!!
Climacteric phase - CORRECT ANSWERS The period of endocrinologic, somatic, and
transitory psychologic changes that occur around the time of menopause.
Early menopause - CORRECT ANSWERS LMP before age 45.
Late menopause - CORRECT ANSWERS LMP after age 54.
Primary ovarian insufficiency - CORRECT ANSWERS Menopause that occurs before age
40.
Early menopause transition (stage -2) - CORRECT ANSWERS Persistent difference of 7
days or more in the length of consecutive cycles.
Late menopause transition (stage -1) - CORRECT ANSWERS 60 or more consecutive days
of amenorrhea.
Luteal out of phase event (LOOP) - CORRECT ANSWERS Explains why some
perimenopausal women have elevated estrogen levels sometimes.
Obese women and estradiol levels during menopause - CORRECT ANSWERS Obese
women are more likely to have anovulatory cycles with high estradiol levels.
Chinese and Japanese women - CORRECT ANSWERS These ethnic groups have lower
estradiol levels than white, black, and Hispanic women.
Stage +2 - CORRECT ANSWERS Late menopause stage: 5-8 years after FMP. Somatic
aging predominates.
Stages +1a, +1b, +1c - CORRECT ANSWERS Early post menopause: 2 years after FMP.
FSH rises, estradiol decreases.
Elevated FSH, LH - CORRECT ANSWERS Endocrine labs after menopause.
AMH, inhibin B - CORRECT ANSWERS These hormones work during reproductive years
to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms - CORRECT ANSWERS
Menstrual cycle variable, persistent >7 day difference between difference in length of consecutive
cycles.
,How to respond if a patient requests FSH lab? - CORRECT ANSWERS Many pitfalls,
variable depending on the day of the cycle you draw the lab.
The potentially superior marker of menopause, a lab. - CORRECT ANSWERS AMH.
DHEA (dehydroepiandrosterone) - CORRECT ANSWERS Adrenal androgens: precursor
hormones produced by the adrenal gland that are enzymatically converted to active androgens or
estrogens in peripheral tissues.
Location of estrogen receptors - CORRECT ANSWERS Vagina, vulva, urethra, trigone of
the bladder.
Effects of estrogen on tissue - CORRECT ANSWERS Maintain blood flow, the collagen,
and HA within the epithelial surfaces.
Vaginal changes with menopause - CORRECT ANSWERS Thinning, loss of elasticity, loss
or absence of rugae.
Vagina and urethra in menopause - CORRECT ANSWERS Vagina narrows, urethra moves
closer to the introitus.
Stress urinary incontinence - CORRECT ANSWERS Vaginal estrogen and urinary
incontinence: what type does it help with?
Treatment for FPHL - CORRECT ANSWERS Minoxidil, spironolactone, finasteride,
estrogen therapy.
Late reproductive years -3b and -3a - CORRECT ANSWERS -3b: menstrual cycles normal,
FSH normal, AMH low, AFC low, inhibin low. -3a: subtle menstrual changes, variable FSH, AMH low,
AFC low, inhibin low.
When it is appropriate to check an FSH during the cycle if you check it? - CORRECT ANSWERS
Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
AFC - CORRECT ANSWERS Antral follicle count. Number of follicles that are detectable
with ultrasound.
Late menopause transition (-1) FSH level on random draw - CORRECT ANSWERS 25 or
higher.
Black women have higher or lower FSH levels? - CORRECT ANSWERS Higher.
Chinese and Japanese women have higher or lower estradiol levels compared to white, black and
Hispanic women? - CORRECT ANSWERS Lower.
Menopause transition-changes in SHBG and testosterone? - CORRECT ANSWERS SHBG
decreases. Testosterone/SHBG ratio increases by 80%.
, Testosterone/SHBG ratio is called what? - CORRECT ANSWERS The free androgen index.
What stage are VMS more likely? - CORRECT ANSWERS +1b (generally last 2 years).
What hormone is generally higher in obese women? - CORRECT ANSWERS Estrone-via
aromatization.
The postmenopausal ovary continues to produce what two hormones? - CORRECT ANSWERS
Testosterone and androstenedione.
Surgical menopause causes women to have lower levels of what hormone? - CORRECT ANSWERS
Testosterone. 40-50% lower than in women w/ intact ovaries.
Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B and
AMH? - CORRECT ANSWERS Inhibin and AMH decrease.
In the menopause transition, women spend more time in what phase? - CORRECT ANSWERS
Luteal-more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition - CORRECT ANSWERS It is felt that the
HPO axis may become less sensitive to estrogen.
In the first year after the FMP, there is no production of what hormone? - CORRECT ANSWERS
Progesterone.
What region of the adrenal gland secretes the androgens? - CORRECT ANSWERS Zona
reticularis.
What are considered the 'adrenal androgens'? - CORRECT ANSWERS DHEA, DHEAS,
Androstenedione.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors.
- CORRECT ANSWERS Angiotensin II, potassium concentration, adrenocorticotropic
hormone secreted by the anterior pituitary.
What part of the pituitary gland secretes adrenocorticotropic hormone? - CORRECT ANSWERS
Anterior pituitary.
Cortisol and HRT - CORRECT ANSWERS Most serum cortisol circulates bound to cortisol
binding globulin.
Do cortisol levels associate with VMS severity? - CORRECT ANSWERS No, cortisol levels
have NOT been associated with more severe VMS.
Local DHEA has been proven to help with what? - CORRECT ANSWERS Vaginal pain and
dyspareunia.
