NAMS Menopause Certification Exam Questions and Answers | Graded A+ | Verified and Updated 2026

NAMS Menopause Certification Exam Questions and Answers | Graded A+ | Verified and Updated 2026 Climacteric phase - answer-The period of endrocrinologic, 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 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 - answer-Obese women are more likely to have anovulatory cycles with high estradiol levels. They are also more likely to have lowerpremenopause yet higher postmenopause estradiol levels compared with women of normal weight. (why they are at higher risk of endometrial cancer) Chinese and Japanese women - answer-These ethnic groups have lower estradiol levels then white, black and hispanic women. stage +2 - answer-late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary symptoms. Stages +1a, +1b, +1c - answer-early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate. 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 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? - answer-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. - answer-AMH DHEA (dehydroepiandrosterone) - answer-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 - 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. Supports microbiome and protects tissue from pathogens. Vaginal changes with menopause - answer-Thinning, loss of elasticity, loss or absence or 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 reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? - 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? and why? - answer-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? - answer-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 - answer-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 - 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? ratio? - answer-SHBG decreases Testosterone/SHBG ratio increases by 80%.Testosterone/SHGB 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? - answertestosterone. 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 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? - 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, 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? - answer-progesterone What region of the adrenal gland secretes the androgens? - answer-zona reticulariswhat 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. The posterior only secretes vasopressin and oxytosin. Cortisol and HRT - answer-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? - 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. ANDelevated FSH over 25 on two occasions at least 4 weeks apart. Anyone 40years old who misses 3+ consecutive cycles gets these labs - answer-prolactin FSH estradiol TSH pregnancy test treatment of POI - answer-100 microgram estradiol patch 1.25 mg CEE 2mg oral estradiol If intact uterus-progesterone for 12 days of the month. Physiologic is better than continuous hormonal contractption, but if menorrhagia-IUD plus estrogen patch, or if really not wanting to risk pregnancy, continuous HRT can be used. Hair loss. Difference between FPHL and telogen effluvium? - answer-FPHL is gradual, telogen effluvium is sudden and usually precipitated by a life stressor, chronic illness, beta blockers or anticoagulants-usually more patchy hair loss. FPHL pattern - answer-thinning at the crown of the head and widening of the hair part Treating FPHL - answer-MINOXIDIL spironolactone finasterideWhat ethnicity has the least likely chance of having bad hot flashes? - answer-Japanese What ethnicity is the most likely to have bad hot flashes? - answer-black more frequent, longer duration. Median length of hot flashes - answer-10 years, early menopause transition women have them the longest. Theories about etiology of hot flashes (6) - answer-lower ovarian estradiol thermoregulation zone is narrowed neurokinins-regulate GnRH secretion. KNDy new meds serotonin cortisol and HPI axis dysregulation endothelial dysfunction. VIN low grade-what to do high grade-what to do differentiated VIN-what to do - answer-low grade is not precancerous high grade is precancerous-GYN ONC differentiated-wide local excision-high risk of invasive carcinoma. most common type of vulvar cancer - answer-squamous cell carcinoma Vulvar disorder commonly misdiagnosed as eczema or dermatitis? - answer-paget's diseasewill not improve on steroids screen for co-existing breast, GI or GU cancer. They are present 20-30% of the time. Normal PVR - answer-100mL systemic and vaginal estrogen will not help with this type of urinary incontinence? - answer-will NOT help with stress incontinence.