NAMS Menopause Certification Exam
Questons and answers Latest 2026 RATED
A+
The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time
of menopause. - CORRECT ANSWERS climacteric phase
Perimenopause Menopause Transition, Early
List the STRAW Stage
What defines the phase? - CORRECT ANSWERS STRAW Stage: (Stage -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
Perimenopause Menopause Transition, Late
List the STRAW Stage
What defines the phase? - CORRECT ANSWERS STRAW Stage: (Stage -1)
60 or more consecutive days of amenorrhea
Luteal out of phase event (LOOP) - CORRECT ANSWERS Explains why some perimenopausal
women have elevated estrogen level sometimes...In the early menopause transition, elevated FSH levels
are adequate to recruit a second follicle which results in a follicular phase-like rise in estradiol secretion
superimposed on the mid-to-late luteal phase of the ongoing ovulatory cycle.
Describe the E2 level during the life of a patient with obesity. - CORRECT ANSWERS They are
also more likely to have lower premenopause/perimenopausal estradiol levels compared to patients
with average BMIs. However, the level is the highest in postmenopausal patients with obesity.
In comparison to other ethnicities, Chinese and Japanese women have ___ E2 levels? - CORRECT
ANSWERS These ethnic groups have lower estradiol levels than white, black and hispanic
women.
STRAW Stage +2, describe the timeline as well as the predominant symptoms. - CORRECT ANSWERS
Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP. Somatic aging predominates. Increased
genitourinary symptoms.
Stages +1a, +1b, +1c, describe the timeline as well as the supportive criteria and the symptoms. -
CORRECT ANSWERS Postmenopause, Early. 2 years after FMP.
+1a/b (2yrs) FSH variable where as the AMH and InhB are low. The AFC are very low. VMS predominate.
1c (3-6yrs) FSH levels stabilize. The other measures continue as previous.
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.
Describe the phases during the early menopause transition and what happens with PMS symptoms -
CORRECT ANSWERS Menstrual cycle shortens. Due to unrestrained FSH, follicular phase
,compresses. More premenstrual symptoms due to the longer luteal phase. Cycle irregularity and
skipped cycles because of ovulatory failure and increased atresia.
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, normal or low FSH is not helpful.
What lab is potentially the superior marker of time to menopause? - CORRECT ANSWERS
AMH
DHEA (dehydroepiandrosterone) - CORRECT ANSWERS Adrenal androgens: precursor
hromones produced by the adrenal gland that are enzymatically converted to active androgens or
estrogens in peripheral tissues.
Location of GU estrogen receptors (4) - CORRECT ANSWERS Vagina, vulva, urethra, trigone of
the bladder
List the effects of estrogen on tissue (4+2) - CORRECT ANSWERS 1 ) maintains blood flow to
tissue, maintains the collagen within the epithelium, and maintains the hyaluronic acid and
mucopolysaccharides within the moistened epithelial surface, maintains pH (4.5) 2) supports
microbiome and protects tissue from pathogens
List the vaginal changes with menopause you might note on clinical/microscopic exam. - CORRECT
ANSWERS Thinning of the epithelial layer, loss of elasticity with narrowing of the canal and
poor distention, noted on pelvic exam with loss or absence or rugae. Due to the decrease in glycogen
content, the lactobacilli are decreased resulting in higher pH.
List the vulvar and urethral changes in menopause. - CORRECT ANSWERS Thinning of the
epithelial layers and vagina narrowing leads the urethra to move 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 reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? -
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? and why? - CORRECT ANSWERS
Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
AMH
produced by...
used to test...
Is it a screening tool for fertility?
, When does it peak? - CORRECT ANSWERS produced by granulosa cells
used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low ovarian reserve.
not recommended as a screening tool to predict fertility.
Peaks at around 25 years old. So before age 25, this test is not helpful.
It is influenced by exogenous hormones. Lower in hormonal contraception users, but increases after
d/cing.
What does AFC stand for? What is considered a normal value? - CORRECT ANSWERS Antral
Follicle Count
> 12 follicles detectable with ultrasound is considered normal
What is the significance of antral follicle count? - CORRECT ANSWERS The ability of the
ovaries to respond. It can represent the number of follicles detectable with ultrasound. It is sensitive to
FSH, and represents the available pool of follicles.
What is the FSH level on a random draw in Late menopause transition (STRAW Stage: -1)? - CORRECT
ANSWERS 25 IU/L 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
What happens to SHBG during menopause? How does that effect the free androgen index? - CORRECT
ANSWERS SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
Testosterone:SHGB 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?
What does that do to FSH? - CORRECT ANSWERS Inhibin B and AMH decrease.
Questons and answers Latest 2026 RATED
A+
The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time
of menopause. - CORRECT ANSWERS climacteric phase
Perimenopause Menopause Transition, Early
List the STRAW Stage
What defines the phase? - CORRECT ANSWERS STRAW Stage: (Stage -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
Perimenopause Menopause Transition, Late
List the STRAW Stage
What defines the phase? - CORRECT ANSWERS STRAW Stage: (Stage -1)
60 or more consecutive days of amenorrhea
Luteal out of phase event (LOOP) - CORRECT ANSWERS Explains why some perimenopausal
women have elevated estrogen level sometimes...In the early menopause transition, elevated FSH levels
are adequate to recruit a second follicle which results in a follicular phase-like rise in estradiol secretion
superimposed on the mid-to-late luteal phase of the ongoing ovulatory cycle.
Describe the E2 level during the life of a patient with obesity. - CORRECT ANSWERS They are
also more likely to have lower premenopause/perimenopausal estradiol levels compared to patients
with average BMIs. However, the level is the highest in postmenopausal patients with obesity.
In comparison to other ethnicities, Chinese and Japanese women have ___ E2 levels? - CORRECT
ANSWERS These ethnic groups have lower estradiol levels than white, black and hispanic
women.
STRAW Stage +2, describe the timeline as well as the predominant symptoms. - CORRECT ANSWERS
Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP. Somatic aging predominates. Increased
genitourinary symptoms.
Stages +1a, +1b, +1c, describe the timeline as well as the supportive criteria and the symptoms. -
CORRECT ANSWERS Postmenopause, Early. 2 years after FMP.
+1a/b (2yrs) FSH variable where as the AMH and InhB are low. The AFC are very low. VMS predominate.
1c (3-6yrs) FSH levels stabilize. The other measures continue as previous.
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.
Describe the phases during the early menopause transition and what happens with PMS symptoms -
CORRECT ANSWERS Menstrual cycle shortens. Due to unrestrained FSH, follicular phase
,compresses. More premenstrual symptoms due to the longer luteal phase. Cycle irregularity and
skipped cycles because of ovulatory failure and increased atresia.
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, normal or low FSH is not helpful.
What lab is potentially the superior marker of time to menopause? - CORRECT ANSWERS
AMH
DHEA (dehydroepiandrosterone) - CORRECT ANSWERS Adrenal androgens: precursor
hromones produced by the adrenal gland that are enzymatically converted to active androgens or
estrogens in peripheral tissues.
Location of GU estrogen receptors (4) - CORRECT ANSWERS Vagina, vulva, urethra, trigone of
the bladder
List the effects of estrogen on tissue (4+2) - CORRECT ANSWERS 1 ) maintains blood flow to
tissue, maintains the collagen within the epithelium, and maintains the hyaluronic acid and
mucopolysaccharides within the moistened epithelial surface, maintains pH (4.5) 2) supports
microbiome and protects tissue from pathogens
List the vaginal changes with menopause you might note on clinical/microscopic exam. - CORRECT
ANSWERS Thinning of the epithelial layer, loss of elasticity with narrowing of the canal and
poor distention, noted on pelvic exam with loss or absence or rugae. Due to the decrease in glycogen
content, the lactobacilli are decreased resulting in higher pH.
List the vulvar and urethral changes in menopause. - CORRECT ANSWERS Thinning of the
epithelial layers and vagina narrowing leads the urethra to move 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 reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? -
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? and why? - CORRECT ANSWERS
Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
AMH
produced by...
used to test...
Is it a screening tool for fertility?
, When does it peak? - CORRECT ANSWERS produced by granulosa cells
used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low ovarian reserve.
not recommended as a screening tool to predict fertility.
Peaks at around 25 years old. So before age 25, this test is not helpful.
It is influenced by exogenous hormones. Lower in hormonal contraception users, but increases after
d/cing.
What does AFC stand for? What is considered a normal value? - CORRECT ANSWERS Antral
Follicle Count
> 12 follicles detectable with ultrasound is considered normal
What is the significance of antral follicle count? - CORRECT ANSWERS The ability of the
ovaries to respond. It can represent the number of follicles detectable with ultrasound. It is sensitive to
FSH, and represents the available pool of follicles.
What is the FSH level on a random draw in Late menopause transition (STRAW Stage: -1)? - CORRECT
ANSWERS 25 IU/L 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
What happens to SHBG during menopause? How does that effect the free androgen index? - CORRECT
ANSWERS SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
Testosterone:SHGB 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?
What does that do to FSH? - CORRECT ANSWERS Inhibin B and AMH decrease.
