NAMs Menopause Certification Exam 2026|
Actual Exam Questions and 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 are they at higher risk of endometrial cancer?
A. Decreased estrone production from adipose tissue
B. Lower postmenopause estradiol levels
C. Higher postmenopause estradiol levels from aromatization in adipose tissue
D. Reduced anovulatory cycles leading to less unopposed estrogen
Correct Answer: C
Explanation: Obese women have higher postmenopause estradiol levels due to increased
aromatization of androgens to estrone in adipose tissue, leading to chronic unopposed estrogen
stimulation of the endometrium and higher risk of endometrial cancer.
These ethnic groups have lower estradiol levels than white, black, and Hispanic women.
A. African American and Hispanic women
B. White and Black women
C. Chinese and Japanese women
D. Hispanic and Native American women
Correct Answer: C
Explanation: Chinese and Japanese women have lower estradiol levels than white, black, and
Hispanic women.
Late menopause stage: 5–8 years after FMP. Somatic aging predominates. Increased
genitourinary symptoms.
A. Stage +1c
B. Stage +2
C. Stage –1
D. Stage –2
,Correct Answer: B
Explanation: Stage +2 is the late postmenopausal stage (5–8 years after final menstrual period)
when somatic aging predominates and genitourinary symptoms increase.
Early postmenopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate.
A. Stages –2 and –1
B. Stages +1a, +1b, +1c
C. Stage +2
D. Stages –3a and –3b
Correct Answer: B
Explanation: Early postmenopause (stages +1a, +1b, +1c) occurs in the first 2 years after the
final menstrual period, when FSH rises, estradiol decreases, and vasomotor symptoms
predominate.
Endocrine labs after menopause
A. Decreased FSH and LH
B. Elevated FSH and LH
C. Elevated estradiol and progesterone
D. Decreased AMH and inhibin B only
Correct Answer: B
Explanation: After menopause, FSH and LH are elevated due to loss of negative feedback from
ovarian hormones.
These hormones work during reproductive years to not deplete follicle pool too quickly.
A. FSH and LH
B. Estradiol and progesterone
C. AMH and inhibin B
D. Testosterone and androstenedione
Correct Answer: C
Explanation: AMH and inhibin B inhibit excessive follicular recruitment, preserving the follicle
pool during reproductive years.
Menstrual cycle variable, persistent >7 day difference between consecutive cycles.
,A. Late menopause transition (stage –1)
B. Early menopause transition (stage –2)
C. Late reproductive years (stage –3)
D. Early postmenopause (stage +1)
Correct Answer: B
Explanation: Persistent >7-day difference in consecutive cycle lengths defines the early
menopause transition (stage –2).
Many pitfalls, variable depending on the day of the cycle you draw the lab, normal or low FSH is
not helpful.
A. How to respond if a patient requests FSH lab?
B. When to check AMH?
C. Interpretation of estradiol levels?
D. Timing of inhibin B testing?
Correct Answer: A
Explanation: FSH testing has many pitfalls; results vary by cycle day and a normal/low FSH
does not rule out perimenopause.
AMH – The potentially superior marker of menopause, a lab.
A. FSH
B. AMH
C. Inhibin B
D. Estradiol
Correct Answer: B
Explanation: AMH is the potentially superior marker of ovarian reserve and menopause
transition.
Adrenal androgens: precursor hormones produced by the adrenal gland that are enzymatically
converted to active androgens or estrogens in peripheral tissues.
A. Cortisol
B. Aldosterone
C. DHEA (dehydroepiandrosterone)
, D. Progesterone
Correct Answer: C
Explanation: DHEA is the primary adrenal androgen precursor converted peripherally to active
sex steroids.
Location of estrogen receptors
A. Only in the uterus and breasts
B. Vagina, vulva, urethra, trigone of the bladder
C. Only in bone and brain
D. Skin and hair follicles only
Correct Answer: B
Explanation: Estrogen receptors are located in the vagina, vulva, urethra, and trigone of the
bladder.
Effects of estrogen on tissue
A. Decreases blood flow and collagen
B. Maintains blood flow, collagen, HA, and supports acidic microbiome
C. Increases keratinization and dryness
D. Reduces vascularity and elasticity
Correct Answer: B
Explanation: Estrogen maintains blood flow, collagen, hyaluronic acid, and supports the vaginal
microbiome that maintains acidity and protects against pathogens.
Vaginal changes with menopause
A. Thickening, increased rugae, increased elasticity
B. Thinning, loss of elasticity, loss or absence of rugae
C. Increased vascularity and glycogen
D. Hypertrophy of the vaginal walls
Correct Answer: B
Explanation: Menopause causes vaginal thinning, loss of elasticity, and loss/absence of rugae.
Actual Exam Questions and 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 are they at higher risk of endometrial cancer?
A. Decreased estrone production from adipose tissue
B. Lower postmenopause estradiol levels
C. Higher postmenopause estradiol levels from aromatization in adipose tissue
D. Reduced anovulatory cycles leading to less unopposed estrogen
Correct Answer: C
Explanation: Obese women have higher postmenopause estradiol levels due to increased
aromatization of androgens to estrone in adipose tissue, leading to chronic unopposed estrogen
stimulation of the endometrium and higher risk of endometrial cancer.
These ethnic groups have lower estradiol levels than white, black, and Hispanic women.
A. African American and Hispanic women
B. White and Black women
C. Chinese and Japanese women
D. Hispanic and Native American women
Correct Answer: C
Explanation: Chinese and Japanese women have lower estradiol levels than white, black, and
Hispanic women.
Late menopause stage: 5–8 years after FMP. Somatic aging predominates. Increased
genitourinary symptoms.
A. Stage +1c
B. Stage +2
C. Stage –1
D. Stage –2
,Correct Answer: B
Explanation: Stage +2 is the late postmenopausal stage (5–8 years after final menstrual period)
when somatic aging predominates and genitourinary symptoms increase.
Early postmenopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate.
A. Stages –2 and –1
B. Stages +1a, +1b, +1c
C. Stage +2
D. Stages –3a and –3b
Correct Answer: B
Explanation: Early postmenopause (stages +1a, +1b, +1c) occurs in the first 2 years after the
final menstrual period, when FSH rises, estradiol decreases, and vasomotor symptoms
predominate.
Endocrine labs after menopause
A. Decreased FSH and LH
B. Elevated FSH and LH
C. Elevated estradiol and progesterone
D. Decreased AMH and inhibin B only
Correct Answer: B
Explanation: After menopause, FSH and LH are elevated due to loss of negative feedback from
ovarian hormones.
These hormones work during reproductive years to not deplete follicle pool too quickly.
A. FSH and LH
B. Estradiol and progesterone
C. AMH and inhibin B
D. Testosterone and androstenedione
Correct Answer: C
Explanation: AMH and inhibin B inhibit excessive follicular recruitment, preserving the follicle
pool during reproductive years.
Menstrual cycle variable, persistent >7 day difference between consecutive cycles.
,A. Late menopause transition (stage –1)
B. Early menopause transition (stage –2)
C. Late reproductive years (stage –3)
D. Early postmenopause (stage +1)
Correct Answer: B
Explanation: Persistent >7-day difference in consecutive cycle lengths defines the early
menopause transition (stage –2).
Many pitfalls, variable depending on the day of the cycle you draw the lab, normal or low FSH is
not helpful.
A. How to respond if a patient requests FSH lab?
B. When to check AMH?
C. Interpretation of estradiol levels?
D. Timing of inhibin B testing?
Correct Answer: A
Explanation: FSH testing has many pitfalls; results vary by cycle day and a normal/low FSH
does not rule out perimenopause.
AMH – The potentially superior marker of menopause, a lab.
A. FSH
B. AMH
C. Inhibin B
D. Estradiol
Correct Answer: B
Explanation: AMH is the potentially superior marker of ovarian reserve and menopause
transition.
Adrenal androgens: precursor hormones produced by the adrenal gland that are enzymatically
converted to active androgens or estrogens in peripheral tissues.
A. Cortisol
B. Aldosterone
C. DHEA (dehydroepiandrosterone)
, D. Progesterone
Correct Answer: C
Explanation: DHEA is the primary adrenal androgen precursor converted peripherally to active
sex steroids.
Location of estrogen receptors
A. Only in the uterus and breasts
B. Vagina, vulva, urethra, trigone of the bladder
C. Only in bone and brain
D. Skin and hair follicles only
Correct Answer: B
Explanation: Estrogen receptors are located in the vagina, vulva, urethra, and trigone of the
bladder.
Effects of estrogen on tissue
A. Decreases blood flow and collagen
B. Maintains blood flow, collagen, HA, and supports acidic microbiome
C. Increases keratinization and dryness
D. Reduces vascularity and elasticity
Correct Answer: B
Explanation: Estrogen maintains blood flow, collagen, hyaluronic acid, and supports the vaginal
microbiome that maintains acidity and protects against pathogens.
Vaginal changes with menopause
A. Thickening, increased rugae, increased elasticity
B. Thinning, loss of elasticity, loss or absence of rugae
C. Increased vascularity and glycogen
D. Hypertrophy of the vaginal walls
Correct Answer: B
Explanation: Menopause causes vaginal thinning, loss of elasticity, and loss/absence of rugae.
