NAMS MENOPAUSE CERTIFICATION EXAM
QUESTIONS AND ANSWERS
secondary causes of osteoporosis
which 3 common drugs? - Answers - Hyperthyroidism, hyperparathyroidism,
hypercalciuria, certain drugs (eg: tamoxifen, steroids, PPIs), calcium/vitamin D
deficiency, RA, celiac disease, malabsorptive diseases such as Crohn disease, and
ulcerative colitis
Median age of menopause in US women - Answers - 52.54 y
POI - Answers - Intermittent ovarian function & insufficient estrogen levels occurring at
age <40 y
which STRAW stage?
menarche / early reproductive - Answers - -5
which STRAW stage?
peak reproductive - Answers - -4
which STRAW stage?
late reproductive - Answers - -3
which STRAW stage?
perimenopause - Answers - -2 to -1 & +1a
which STRAW stage?
FMP &
12 months after final menstrual period - Answers - FMP = 0
12 months after = +1a
which STRAW stage?
VMS most likely - Answers - +1a (most likely)
-1 (likely)
aka perimenopause/menopause transition
,which STRAW stage?
early post menopause - Answers - +1a to +1c
which STRAW stage?
late postmenopause - Answers - +2
which STRAW stage?
amenorrhea >60 days - Answers - -1
aka late menopause transition
which STRAW stage?
variable cycle lengths of >7 days differences - Answers - -2
aka early menopause transition
difference between menopause transition vs perimenopause per STRAW criteria? -
Answers - menopause transition: -2 and -1, prior to FMP
perimenopause: -2 to +1a, includes 12 mo of amenorrhea following FMP
which STRAW stage?
initial drop in AMH/AFC/inhibin, cycles still regular, FSH normal - Answers - -3b
aka late reproductive
which STRAW stage?
cycles shorter, first increase in FSH - Answers - -3a
aka late reproductive
levels spike with ovulation, marker of ovarian reserve - Answers - inhibin B
Produced by granulosa cells of activated follicles, most reflective of true ovarian
reserve; provides the best single prediction of time to menopause - Answers - AMH
what day of cycle to draw FSH to predict ovarian response/reserve? - Answers - day 3
normal day 3 FSH?
FSH value for menopause? - Answers - < 10
, >25
# of ultrasound detected follicles 2-10 mm in size - Answers - AFC (antral follicle count)
normal AFC - Answers - >12
Luteal-Out-Of-Phase (LOOP) event - Answers - - FSH elevation recruits follicles for the
subsequent cycle before the current cycle is over
- Excess estradiol production as new follicles start growing
- Increase chance of TWINS
- Very short follicular phase
- More time spent in luteal phase (more PMS/PMDD sx)
symptoms of LOOP event - Answers - —Mastalgia
—Worsening migraine
—Growing fibroids
—Risk of endometrial hyperplasia
- longer time in luteal phase (worsening PMDD in peri)
premenopausal vs postmenopausal estradiol levels in obesity - Answers - pre: lower,
more anovulatory cycles
post: higher
consequence of inhibin B and AMH drop in early menopause transition? - Answers -
FSH spikes --> fast growth of remaining follicles (twins more likely) --> shorter follicular
phase --> follicle atresia --> LOOP cycles --> pronounced PMS sx from longer luteal
phase --> cycle irregularity by >7 days
dec ovarian reserve causes the drop in what 2 hormones? - Answers - inhibin B and
AMH
4 adrenal androgens - Answers - —Dehydroepiandrosterone (DHEA)
—Dehydroepiandrosterone sulfate (DHEAS)
—Androstenedione
—Testosterone
where are adrenal androgens converted to estrogen? - Answers - peripheral tissue
what happens to DHEA levels during menopause transition? - Answers - transient
increase then return to premenopause baseline
is DHEA supplementation in menopause recommended? - Answers - no
QUESTIONS AND ANSWERS
secondary causes of osteoporosis
which 3 common drugs? - Answers - Hyperthyroidism, hyperparathyroidism,
hypercalciuria, certain drugs (eg: tamoxifen, steroids, PPIs), calcium/vitamin D
deficiency, RA, celiac disease, malabsorptive diseases such as Crohn disease, and
ulcerative colitis
Median age of menopause in US women - Answers - 52.54 y
POI - Answers - Intermittent ovarian function & insufficient estrogen levels occurring at
age <40 y
which STRAW stage?
menarche / early reproductive - Answers - -5
which STRAW stage?
peak reproductive - Answers - -4
which STRAW stage?
late reproductive - Answers - -3
which STRAW stage?
perimenopause - Answers - -2 to -1 & +1a
which STRAW stage?
FMP &
12 months after final menstrual period - Answers - FMP = 0
12 months after = +1a
which STRAW stage?
VMS most likely - Answers - +1a (most likely)
-1 (likely)
aka perimenopause/menopause transition
,which STRAW stage?
early post menopause - Answers - +1a to +1c
which STRAW stage?
late postmenopause - Answers - +2
which STRAW stage?
amenorrhea >60 days - Answers - -1
aka late menopause transition
which STRAW stage?
variable cycle lengths of >7 days differences - Answers - -2
aka early menopause transition
difference between menopause transition vs perimenopause per STRAW criteria? -
Answers - menopause transition: -2 and -1, prior to FMP
perimenopause: -2 to +1a, includes 12 mo of amenorrhea following FMP
which STRAW stage?
initial drop in AMH/AFC/inhibin, cycles still regular, FSH normal - Answers - -3b
aka late reproductive
which STRAW stage?
cycles shorter, first increase in FSH - Answers - -3a
aka late reproductive
levels spike with ovulation, marker of ovarian reserve - Answers - inhibin B
Produced by granulosa cells of activated follicles, most reflective of true ovarian
reserve; provides the best single prediction of time to menopause - Answers - AMH
what day of cycle to draw FSH to predict ovarian response/reserve? - Answers - day 3
normal day 3 FSH?
FSH value for menopause? - Answers - < 10
, >25
# of ultrasound detected follicles 2-10 mm in size - Answers - AFC (antral follicle count)
normal AFC - Answers - >12
Luteal-Out-Of-Phase (LOOP) event - Answers - - FSH elevation recruits follicles for the
subsequent cycle before the current cycle is over
- Excess estradiol production as new follicles start growing
- Increase chance of TWINS
- Very short follicular phase
- More time spent in luteal phase (more PMS/PMDD sx)
symptoms of LOOP event - Answers - —Mastalgia
—Worsening migraine
—Growing fibroids
—Risk of endometrial hyperplasia
- longer time in luteal phase (worsening PMDD in peri)
premenopausal vs postmenopausal estradiol levels in obesity - Answers - pre: lower,
more anovulatory cycles
post: higher
consequence of inhibin B and AMH drop in early menopause transition? - Answers -
FSH spikes --> fast growth of remaining follicles (twins more likely) --> shorter follicular
phase --> follicle atresia --> LOOP cycles --> pronounced PMS sx from longer luteal
phase --> cycle irregularity by >7 days
dec ovarian reserve causes the drop in what 2 hormones? - Answers - inhibin B and
AMH
4 adrenal androgens - Answers - —Dehydroepiandrosterone (DHEA)
—Dehydroepiandrosterone sulfate (DHEAS)
—Androstenedione
—Testosterone
where are adrenal androgens converted to estrogen? - Answers - peripheral tissue
what happens to DHEA levels during menopause transition? - Answers - transient
increase then return to premenopause baseline
is DHEA supplementation in menopause recommended? - Answers - no
