NAMS MENOPAUSE CERTIFICATION EXAM 2026
QUESTIONS WITH ANSWERS LATEST UPDATE
The period of endocrinologic, somatic, and transitory psychologic changes that occur
around the time of menopause.
climacteric phase
Perimenopause Menopause Transition, Early
List the STRAW Stage
What defines the phase?
STRAW Stage: (Stage -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
Perimenopause Menopause Transition, Late
List the STRAW Stage
What defines the phase?
STRAW Stage: (Stage -1)
60 or more consecutive days of amenorrhea
Luteal out of phase event (LOOP)
,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.
Describe the E2 level during the life of a patient with obesity.
They are also more likely to have lower premenopause/perimenopausal estradiol levels
compared to patients with average BMIs. However, the level is the highest in
postmenopausal patients with obesity.
In comparison to other ethnicities, Chinese and Japanese women have ___ E2 levels?
These ethnic groups have lower estradiol levels than white, black and Hispanic women.
STRAW Stage +2, describe the timeline as well as the predominant symptoms.
Post menopause, Late. (Remaining Lifespan) 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c, describe the timeline as well as the supportive criteria and the
symptoms.
Post menopause, Early. 2 years after FMP.
+1a/b (2yrs) FSH variable where as the AMH and InhB are low. The AFC are very low.
VMS predominate.
1c (3-6yrs) FSH levels stabilize. The other measures continue as previous.
Elevated FSH, LH
,Endocrine labs after menopause
AMH, Inhibin B
These hormones work during reproductive years to not deplete follicle pool too quickly.
Describe the phases during the early menopause transition and what happens with
PMS symptoms
Menstrual cycle shortens. Due to unrestrained FSH, follicular phase compresses. More
premenstrual symptoms due to the longer luteal phase. Cycle irregularity and skipped
cycles because of ovulatory failure and increased atresia.
How to respond if a patient requests FSH lab?
many pitfalls, variable depending on the day of the cycle you draw the lab, normal or
low FSH is not helpful.
What lab is potentially the superior marker of time to menopause?
AMH
DHEA (dehydroepiandrosterone)
Adrenal androgens: precursor hormones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in peripheral tissues.
Location of GU estrogen receptors (4)
, Vagina, vulva, urethra, trigone of the bladder
List the effects of estrogen on tissue (4+2)
1 ) maintains blood flow to tissue, maintains the collagen within the epithelium, and
maintains the hyaluronic acid and mucopolysaccharides within the moistened epithelial
surface, maintains pH (4.5) 2) supports microbiome and protects tissue from pathogens
List the vaginal changes with menopause you might note on clinical/microscopic exam.
Thinning of the epithelial layer, loss of elasticity with narrowing of the canal and poor
distention, noted on pelvic exam with loss or absence or rugae. Due to the decrease in
glycogen content, the lactobacilli are decreased resulting in higher pH.
List the vulvar and urethral changes in menopause.
Thinning of the epithelial layers and vagina narrowing leads the urethra to move closer
to the introitus.
Stress urinary incontinence
Vaginal estrogen and urinary incontinence: what type does it help with?
Treatment For FPHL
Minoxidil, Spironolactone, Finasteride, Estrogen Therapy
QUESTIONS WITH ANSWERS LATEST UPDATE
The period of endocrinologic, somatic, and transitory psychologic changes that occur
around the time of menopause.
climacteric phase
Perimenopause Menopause Transition, Early
List the STRAW Stage
What defines the phase?
STRAW Stage: (Stage -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
Perimenopause Menopause Transition, Late
List the STRAW Stage
What defines the phase?
STRAW Stage: (Stage -1)
60 or more consecutive days of amenorrhea
Luteal out of phase event (LOOP)
,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.
Describe the E2 level during the life of a patient with obesity.
They are also more likely to have lower premenopause/perimenopausal estradiol levels
compared to patients with average BMIs. However, the level is the highest in
postmenopausal patients with obesity.
In comparison to other ethnicities, Chinese and Japanese women have ___ E2 levels?
These ethnic groups have lower estradiol levels than white, black and Hispanic women.
STRAW Stage +2, describe the timeline as well as the predominant symptoms.
Post menopause, Late. (Remaining Lifespan) 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c, describe the timeline as well as the supportive criteria and the
symptoms.
Post menopause, Early. 2 years after FMP.
+1a/b (2yrs) FSH variable where as the AMH and InhB are low. The AFC are very low.
VMS predominate.
1c (3-6yrs) FSH levels stabilize. The other measures continue as previous.
Elevated FSH, LH
,Endocrine labs after menopause
AMH, Inhibin B
These hormones work during reproductive years to not deplete follicle pool too quickly.
Describe the phases during the early menopause transition and what happens with
PMS symptoms
Menstrual cycle shortens. Due to unrestrained FSH, follicular phase compresses. More
premenstrual symptoms due to the longer luteal phase. Cycle irregularity and skipped
cycles because of ovulatory failure and increased atresia.
How to respond if a patient requests FSH lab?
many pitfalls, variable depending on the day of the cycle you draw the lab, normal or
low FSH is not helpful.
What lab is potentially the superior marker of time to menopause?
AMH
DHEA (dehydroepiandrosterone)
Adrenal androgens: precursor hormones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in peripheral tissues.
Location of GU estrogen receptors (4)
, Vagina, vulva, urethra, trigone of the bladder
List the effects of estrogen on tissue (4+2)
1 ) maintains blood flow to tissue, maintains the collagen within the epithelium, and
maintains the hyaluronic acid and mucopolysaccharides within the moistened epithelial
surface, maintains pH (4.5) 2) supports microbiome and protects tissue from pathogens
List the vaginal changes with menopause you might note on clinical/microscopic exam.
Thinning of the epithelial layer, loss of elasticity with narrowing of the canal and poor
distention, noted on pelvic exam with loss or absence or rugae. Due to the decrease in
glycogen content, the lactobacilli are decreased resulting in higher pH.
List the vulvar and urethral changes in menopause.
Thinning of the epithelial layers and vagina narrowing leads the urethra to move closer
to the introitus.
Stress urinary incontinence
Vaginal estrogen and urinary incontinence: what type does it help with?
Treatment For FPHL
Minoxidil, Spironolactone, Finasteride, Estrogen Therapy
