NAMS Certification Exam QUESTIONS
AND ANSWERS 100- SOLVED (Newest
Version 2025 Best Exam Prep)
Climacteric phase - CORRECT ANSWERS-The period of endrocrinologic, 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 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.
Obese women and estradiol levels during menopause - CORRECT ANSWERS-Obese
women are more likely to have anovulatory cycles with high estradiol levels. They are
also more likely to have lower premenopause yet higher postmenopause estradiol
levels compared with women of normal weight. (why they are at higher risk of
endometrial cancer)
Chinese and Japanese women - CORRECT ANSWERS-These ethnic groups have
lower estradiol levels then white, black and hispanic women.
stage +2 - CORRECT ANSWERS-late menopause stage: 5-8 years after FMP. Somatic
aging predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - CORRECT ANSWERS-early post menopause: 2 years after
FMP. FSH rises, estradiol decreases. VMS predominate.
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 shortenes, follicular phase compresses, women spend more time in
luteal phase.. meaning more premenstrual symptoms and more frequent menstrual
periods.
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.
The potentially superior marker of menopause, a lab. - 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 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. Supports microbiome and protects tissue from
pathogens.
Vaginal changes with menopause - CORRECT ANSWERS-Thinning, loss of elasticity,
loss or absence or 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 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.
AFC - CORRECT ANSWERS-Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability poo of follicles.
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? ratio? - 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? - CORRECT ANSWERS-inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining,
diminished follicle pool.
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, so even with good follicle growth
and estradiol secretion, LH surges can fail which can lead to more cycle irregularity.
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. The posterior only secretes vasopressin and oxytosin.
Cortisol and HRT - CORRECT ANSWERS-Most serum cortisol circulates bound to
cortisol binding globulin.
Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol
concentration.
Do cortisol levels associate with VMS severity? - CORRECT ANSWERS-No, cortisol
levels have NOT been associated with more severe VMS.
AND ANSWERS 100- SOLVED (Newest
Version 2025 Best Exam Prep)
Climacteric phase - CORRECT ANSWERS-The period of endrocrinologic, 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 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.
Obese women and estradiol levels during menopause - CORRECT ANSWERS-Obese
women are more likely to have anovulatory cycles with high estradiol levels. They are
also more likely to have lower premenopause yet higher postmenopause estradiol
levels compared with women of normal weight. (why they are at higher risk of
endometrial cancer)
Chinese and Japanese women - CORRECT ANSWERS-These ethnic groups have
lower estradiol levels then white, black and hispanic women.
stage +2 - CORRECT ANSWERS-late menopause stage: 5-8 years after FMP. Somatic
aging predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - CORRECT ANSWERS-early post menopause: 2 years after
FMP. FSH rises, estradiol decreases. VMS predominate.
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 shortenes, follicular phase compresses, women spend more time in
luteal phase.. meaning more premenstrual symptoms and more frequent menstrual
periods.
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.
The potentially superior marker of menopause, a lab. - 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 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. Supports microbiome and protects tissue from
pathogens.
Vaginal changes with menopause - CORRECT ANSWERS-Thinning, loss of elasticity,
loss or absence or 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 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.
AFC - CORRECT ANSWERS-Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability poo of follicles.
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? ratio? - 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? - CORRECT ANSWERS-inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining,
diminished follicle pool.
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, so even with good follicle growth
and estradiol secretion, LH surges can fail which can lead to more cycle irregularity.
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. The posterior only secretes vasopressin and oxytosin.
Cortisol and HRT - CORRECT ANSWERS-Most serum cortisol circulates bound to
cortisol binding globulin.
Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol
concentration.
Do cortisol levels associate with VMS severity? - CORRECT ANSWERS-No, cortisol
levels have NOT been associated with more severe VMS.
