NAMS MENOPAUSE CERTIFICATION EXAM
CERTIFICATION EVALUATION 2026 QUESTIONS
WITH PRACTICE SOLUTION GRADED A+
◉ 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 lower
premenopause 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 variable, persistent >7 day difference between
difference in length of consecutive cycles.
,◉ 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 which supports acidity of vagina 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?
CERTIFICATION EVALUATION 2026 QUESTIONS
WITH PRACTICE SOLUTION GRADED A+
◉ 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 lower
premenopause 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 variable, persistent >7 day difference between
difference in length of consecutive cycles.
,◉ 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 which supports acidity of vagina 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?
