2026-2027 NAMs Menopause
Certification Exam | Questions And
Answers |
Climacteric phase -ANSWER The period of endocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause -ANSWER LMP before age 45.
Late menopause -ANSWER LMP after age 54.
Primary ovarian insufficiency -ANSWER Menopause that occurs before age 40.
Early menopause transition (stage -2) -ANSWER Persistent difference of 7 days or more
in the length of consecutive cycles.
Late menopause transition (stage -1) -ANSWER 60 or more consecutive days of
amenorrhea.
Luteal out of phase event (LOOP) -ANSWER Explains why some perimenopausal women
have elevated estrogen levels sometimes.
Obese women and estradiol levels during menopause -ANSWER Obese women are more
likely to have anovulatory cycles with high estradiol levels.
Chinese and Japanese women -ANSWER These ethnic groups have lower estradiol
levels than white, black, and Hispanic women.
Stage +2 -ANSWER Late menopause stage: 5-8 years after FMP. Somatic aging
predominates.
Stages +1a, +1b, +1c -ANSWER Early post menopause: 2 years after FMP. FSH rises,
estradiol decreases.
Elevated FSH, LH -ANSWER Endocrine labs after menopause.
AMH, inhibin B -ANSWER These hormones work during reproductive years to not deplete
follicle pool too quickly.
Phases during menopause transition and PMS symptoms -ANSWER Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive
cycles.
,How to respond if a patient requests FSH lab? -ANSWER Many pitfalls, variable
depending on the day of the cycle you draw the lab.
The potentially superior marker of menopause, a lab. -ANSWER AMH.
DHEA (dehydroepiandrosterone) -ANSWER 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 -ANSWER Vagina, vulva, urethra, trigone of the bladder.
Effects of estrogen on tissue -ANSWER Maintain blood flow, the collagen, and HA within
the epithelial surfaces.
Vaginal changes with menopause -ANSWER Thinning, loss of elasticity, loss or absence
of rugae.
Vagina and urethra in menopause -ANSWER Vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence -ANSWER Vaginal estrogen and urinary incontinence: what
type does it help with?
Treatment for FPHL -ANSWER Minoxidil, spironolactone, finasteride, estrogen therapy.
Late reproductive years -3b and -3a -ANSWER -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? -ANSWER Cycle
day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
AFC -ANSWER Antral follicle count. Number of follicles that are detectable with
ultrasound.
Late menopause transition (-1) FSH level on random draw -ANSWER 25 or higher.
Black women have higher or lower FSH levels? -ANSWER Higher.
Chinese and Japanese women have higher or lower estradiol levels compared to white,
black and Hispanic women? -ANSWER Lower.
Menopause transition-changes in SHBG and testosterone? -ANSWER SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHBG ratio is called what? -ANSWER The free androgen index.
, What stage are VMS more likely? -ANSWER +1b (generally last 2 years).
What hormone is generally higher in obese women? -ANSWER Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones? -ANSWER
Testosterone and androstenedione.
Surgical menopause causes women to have lower levels of what hormone? -ANSWER
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? -ANSWER Inhibin and AMH decrease.
In the menopause transition, women spend more time in what phase? -ANSWER Luteal-
more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition -ANSWER 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? -ANSWER
Progesterone.
What region of the adrenal gland secretes the androgens? -ANSWER Zona reticularis.
What are considered the 'adrenal androgens'? -ANSWER DHEA, DHEAS,
Androstenedione.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3
main factors. -ANSWER Angiotensin II, potassium concentration, adrenocorticotropic
hormone secreted by the anterior pituitary.
What part of the pituitary gland secretes adrenocorticotropic hormone? -ANSWER Anterior
pituitary.
Cortisol and HRT -ANSWER Most serum cortisol circulates bound to cortisol binding
globulin.
Do cortisol levels associate with VMS severity? -ANSWER No, cortisol levels have NOT
been associated with more severe VMS.
Local DHEA has been proven to help with what? -ANSWER Vaginal pain and
dyspareunia.
How to DX POI? -ANSWER Menstrual disturbance-oligomenorrhea or amenorrhea for at
least 4 months and elevated FSH over 25 on two occasions at least 4 weeks apart.
Certification Exam | Questions And
Answers |
Climacteric phase -ANSWER The period of endocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause -ANSWER LMP before age 45.
Late menopause -ANSWER LMP after age 54.
Primary ovarian insufficiency -ANSWER Menopause that occurs before age 40.
Early menopause transition (stage -2) -ANSWER Persistent difference of 7 days or more
in the length of consecutive cycles.
Late menopause transition (stage -1) -ANSWER 60 or more consecutive days of
amenorrhea.
Luteal out of phase event (LOOP) -ANSWER Explains why some perimenopausal women
have elevated estrogen levels sometimes.
Obese women and estradiol levels during menopause -ANSWER Obese women are more
likely to have anovulatory cycles with high estradiol levels.
Chinese and Japanese women -ANSWER These ethnic groups have lower estradiol
levels than white, black, and Hispanic women.
Stage +2 -ANSWER Late menopause stage: 5-8 years after FMP. Somatic aging
predominates.
Stages +1a, +1b, +1c -ANSWER Early post menopause: 2 years after FMP. FSH rises,
estradiol decreases.
Elevated FSH, LH -ANSWER Endocrine labs after menopause.
AMH, inhibin B -ANSWER These hormones work during reproductive years to not deplete
follicle pool too quickly.
Phases during menopause transition and PMS symptoms -ANSWER Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive
cycles.
,How to respond if a patient requests FSH lab? -ANSWER Many pitfalls, variable
depending on the day of the cycle you draw the lab.
The potentially superior marker of menopause, a lab. -ANSWER AMH.
DHEA (dehydroepiandrosterone) -ANSWER 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 -ANSWER Vagina, vulva, urethra, trigone of the bladder.
Effects of estrogen on tissue -ANSWER Maintain blood flow, the collagen, and HA within
the epithelial surfaces.
Vaginal changes with menopause -ANSWER Thinning, loss of elasticity, loss or absence
of rugae.
Vagina and urethra in menopause -ANSWER Vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence -ANSWER Vaginal estrogen and urinary incontinence: what
type does it help with?
Treatment for FPHL -ANSWER Minoxidil, spironolactone, finasteride, estrogen therapy.
Late reproductive years -3b and -3a -ANSWER -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? -ANSWER Cycle
day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
AFC -ANSWER Antral follicle count. Number of follicles that are detectable with
ultrasound.
Late menopause transition (-1) FSH level on random draw -ANSWER 25 or higher.
Black women have higher or lower FSH levels? -ANSWER Higher.
Chinese and Japanese women have higher or lower estradiol levels compared to white,
black and Hispanic women? -ANSWER Lower.
Menopause transition-changes in SHBG and testosterone? -ANSWER SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHBG ratio is called what? -ANSWER The free androgen index.
, What stage are VMS more likely? -ANSWER +1b (generally last 2 years).
What hormone is generally higher in obese women? -ANSWER Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones? -ANSWER
Testosterone and androstenedione.
Surgical menopause causes women to have lower levels of what hormone? -ANSWER
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? -ANSWER Inhibin and AMH decrease.
In the menopause transition, women spend more time in what phase? -ANSWER Luteal-
more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition -ANSWER 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? -ANSWER
Progesterone.
What region of the adrenal gland secretes the androgens? -ANSWER Zona reticularis.
What are considered the 'adrenal androgens'? -ANSWER DHEA, DHEAS,
Androstenedione.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3
main factors. -ANSWER Angiotensin II, potassium concentration, adrenocorticotropic
hormone secreted by the anterior pituitary.
What part of the pituitary gland secretes adrenocorticotropic hormone? -ANSWER Anterior
pituitary.
Cortisol and HRT -ANSWER Most serum cortisol circulates bound to cortisol binding
globulin.
Do cortisol levels associate with VMS severity? -ANSWER No, cortisol levels have NOT
been associated with more severe VMS.
Local DHEA has been proven to help with what? -ANSWER Vaginal pain and
dyspareunia.
How to DX POI? -ANSWER Menstrual disturbance-oligomenorrhea or amenorrhea for at
least 4 months and elevated FSH over 25 on two occasions at least 4 weeks apart.
