NAMS CERTIFICATION EXAM STUDY GUIDE
Early Menopause - Answers - FMP before age 45
Late Menopause - Answers - FMP after age 54
Bilateral oophorectomy prior to age 45 increases risks for: - Answers - - All cause
mortality
- Coronary heart disease
- CVD
- Menopause symptoms
- Worsening mood symptoms
- Higher incidence of Parkinson Disease
- Associated with cognitive impairment
Early Menopause Transition (-2) - Answers - 7 or more days persistent difference in
cycle length from previous normal cycle
- Results of increased follicular aging and depletion
- Inhibin B decreases
- FSH increases (Variable)
LOOP Cycles - Answers - Explains elevation of Estradiol in perimenopause
- Rising FSH levels recruit 2nd follicle during luteal phase which leads to overproduction
of Estradiol
- This causes menstrual changes in future cycles
Decreased AMH in Early Menopause Transition - Answers - More frequent anovulatory
cycles
Decreased Inhibin B in Early Menopause Transition - Answers - - Skipped menstrual
cycles
- Mastalgia
- Migraine
- Menorrhagia (with LOOP cycles)
- Endometrial Hyperplasia
Late Menopause Transition (-1) - Answers - 60 or more days of amenorrhea for women
aged 45 years or older
- Women 40-44 years with recurrent episodes of amenorrhea of 60 day for longer within
a year improves prediction of entry into late menopause transition
Late Menopause Transition (-1) Duration - Answers - 1-3 years
Late Menopause Transition (-1) Symptoms - Answers - VMS likely
, STRAW Stage where FSH > 25 - Answers - Late Menopause Transition (-1)
Elevated FSH symptoms in Late Menopause Transition - Answers - - VMS
- Sleep disturbance
- Changes in weight distribution
- Increased variability in cycle length
Decreased Inhibin B in Late Menopause Transition - Answers - - Mood changes
- Cognitive complaints
- Changes in sexual functioning
- Increased prevalence of anovulation
Decreased AMH in Late Menopause Transition - Answers - - GSM
- Bone loss
- CVD issues
- Interval of amenorrhea > 60 days
POI - Answers - Menopause before age 40
POI diagnosis - Answers - - Oligomenorrhea or amenorrhea x 4 months
- FSH > 25 on two occasions at least 4 weeks apart
POI Symptoms - Answers - - Hot flashes
- Mood changes - depression
- Insomnia
- Vaginal dryness, dyspareunia
POI Management - Answers - HT until average of menopause
Early Menopause Risks (natural or surgical) - Answers - - CVD
- Low bone density
- Memory for verbal information compromised
- Low libido due to decreased testosterone
- Depression due to fertility
Ovarian Reserve Lab - Answers - - Antral follicle count & AMH
Secondary Amenorrhea differential with low FSH - Answers - - Pregnancy
- Hypothalamic amenorrhea (e.g., Diabetes, celiac disease, excessive exercise/caloric
restriction, stress, lesions of hypothalamus/pituitary)
- Hyperprolactinemia
- Thyroid disease
- PCOS
Adrenal Insufficiency - Answers - - Hypofunction of adrenal gland and pituitary gland
- Diagnosed by low cortisol at baseline
Early Menopause - Answers - FMP before age 45
Late Menopause - Answers - FMP after age 54
Bilateral oophorectomy prior to age 45 increases risks for: - Answers - - All cause
mortality
- Coronary heart disease
- CVD
- Menopause symptoms
- Worsening mood symptoms
- Higher incidence of Parkinson Disease
- Associated with cognitive impairment
Early Menopause Transition (-2) - Answers - 7 or more days persistent difference in
cycle length from previous normal cycle
- Results of increased follicular aging and depletion
- Inhibin B decreases
- FSH increases (Variable)
LOOP Cycles - Answers - Explains elevation of Estradiol in perimenopause
- Rising FSH levels recruit 2nd follicle during luteal phase which leads to overproduction
of Estradiol
- This causes menstrual changes in future cycles
Decreased AMH in Early Menopause Transition - Answers - More frequent anovulatory
cycles
Decreased Inhibin B in Early Menopause Transition - Answers - - Skipped menstrual
cycles
- Mastalgia
- Migraine
- Menorrhagia (with LOOP cycles)
- Endometrial Hyperplasia
Late Menopause Transition (-1) - Answers - 60 or more days of amenorrhea for women
aged 45 years or older
- Women 40-44 years with recurrent episodes of amenorrhea of 60 day for longer within
a year improves prediction of entry into late menopause transition
Late Menopause Transition (-1) Duration - Answers - 1-3 years
Late Menopause Transition (-1) Symptoms - Answers - VMS likely
, STRAW Stage where FSH > 25 - Answers - Late Menopause Transition (-1)
Elevated FSH symptoms in Late Menopause Transition - Answers - - VMS
- Sleep disturbance
- Changes in weight distribution
- Increased variability in cycle length
Decreased Inhibin B in Late Menopause Transition - Answers - - Mood changes
- Cognitive complaints
- Changes in sexual functioning
- Increased prevalence of anovulation
Decreased AMH in Late Menopause Transition - Answers - - GSM
- Bone loss
- CVD issues
- Interval of amenorrhea > 60 days
POI - Answers - Menopause before age 40
POI diagnosis - Answers - - Oligomenorrhea or amenorrhea x 4 months
- FSH > 25 on two occasions at least 4 weeks apart
POI Symptoms - Answers - - Hot flashes
- Mood changes - depression
- Insomnia
- Vaginal dryness, dyspareunia
POI Management - Answers - HT until average of menopause
Early Menopause Risks (natural or surgical) - Answers - - CVD
- Low bone density
- Memory for verbal information compromised
- Low libido due to decreased testosterone
- Depression due to fertility
Ovarian Reserve Lab - Answers - - Antral follicle count & AMH
Secondary Amenorrhea differential with low FSH - Answers - - Pregnancy
- Hypothalamic amenorrhea (e.g., Diabetes, celiac disease, excessive exercise/caloric
restriction, stress, lesions of hypothalamus/pituitary)
- Hyperprolactinemia
- Thyroid disease
- PCOS
Adrenal Insufficiency - Answers - - Hypofunction of adrenal gland and pituitary gland
- Diagnosed by low cortisol at baseline
