NAMs Menopause Certification
Exam2025/2026
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 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
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.
Exam2025/2026
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 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
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.
