NAMS Menopause Certification | Questions and Answers | 2026 Update | Exam
Review Pack
1. Climacteric phase: The period of endocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
2. Early menopause: LMP before age 45.
3. Late menopause: LMP after age 54.
4. Primary ovarian insufficiency: Menopause that occurs before age 40.
5. Early menopause transition (stage -2): Persistent difference of 7 days or more
in the length of consecutive cycles.
6. Late menopause transition (stage -1): 60 or more consecutive days of
amenorrhea.
7. Luteal out of phase event (LOOP): Explains why some perimenopausal
women have altered estrogen levels.
8. Obese women and estradiol levels during menopause: Obese women are more
likely to have anovulatory cycles with high estradiol levels.
9. Chinese and Japanese women: These ethnic groups have lower estradiol
levels than white, black, and Hispanic women.
10. Stage +2: Late menopause stage: 5-8 years after FMP. Somatic aging
predominates.
11. Stages +1a, +1b, +1c: Early post menopause: 2 years after FMP. FSH rises,
estradiol decreases.
12. Elevated FSH, LH: Endocrine labs after menopause.
13. AMH, inhibin B: These hormones work during reproductive years to not
deplete follicle pool too quickly.
14. Phases during menopause transition and PMS symptoms: Menstrual cycle
variable, persistent >7 day difference between difference in length of
consecutive cycles.
15. How to respond if a patient requests FSH lab? Many pitfalls, variable
depending on the day of the cycle you draw the lab.
16. The potentially superior marker of menopause, a lab. AMH.
17. DHEA (dehydroepiandrosterone): Adrenal androgens: precursor hormones
produced by the adrenal gland that are enzymatically converted to active
androgens or estrogens in peripheral tissues.
18. Location of estrogen receptors: Vagina, vulva, urethra, trigone of the bladder.
, 19. Effects of estrogen on tissue: Maintain blood flow, the collagen, and HA
within the epithelial surfaces.
20. Vaginal changes with menopause: Thinning, loss of elasticity, loss or
absence of rugae.
21. Vagina and urethra in menopause: Vagina narrows, urethra moves closer to
the introitus.
22. Stress urinary incontinence: Vaginal estrogen and urinary incontinence: what
type does it help with?
23. Treatment for FPHL: Minoxidil, spironolactone, finasteride, estrogen
therapy.
24. Late reproductive years -3b and -3a: -3b: menstrual cycles normal, FSH
normal, AMH low, AFC low, inhibin low. -3a: subtle menstrual changes,
variable FSH, AMH low, AFC low, inhibin low.
25. When it is appropriate to check an FSH during the cycle if you check it? Cycle
day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH
level.
26. AFC: Antral follicle count. Number of follicles that are detectable with
ultrasound.
27. Late menopause transition (-1) FSH level on random draw: 25 or higher.
28. Black women have higher or lower FSH levels? Higher.
29. Chinese and Japanese women have higher or lower estradiol levels compared to
white, black and Hispanic women? Lower.
30. Menopause transition-changes in SHBG and testosterone? SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
31. Testosterone/SHBG ratio is called what? The free androgen index.
32. What stage is VMS more likely? +1b (generally last 2 years).
33. What hormone is generally higher in obese women? Estrone-via aromatization.
34. The postmenopausal ovary continues to produce what two
hormones? Testosterone and androstenedione.
35. Surgical menopause causes women to have lower levels of what
hormone? Testosterone. 40-50% lower than in women w/ intact ovaries.
36. Driving piece of menopause is ovarian follicles depleting. What does this do to
the inhibin B and AMH? Inhibin and AMH decrease.
37. In the menopause transition, women spend more time in what phase? Luteal-
more PMS symptoms, more frequent menstrual periods.
38. HPO axis theory and the menopause transition: It is felt that the HPO axis may
become less sensitive to estrogen.
Review Pack
1. Climacteric phase: The period of endocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
2. Early menopause: LMP before age 45.
3. Late menopause: LMP after age 54.
4. Primary ovarian insufficiency: Menopause that occurs before age 40.
5. Early menopause transition (stage -2): Persistent difference of 7 days or more
in the length of consecutive cycles.
6. Late menopause transition (stage -1): 60 or more consecutive days of
amenorrhea.
7. Luteal out of phase event (LOOP): Explains why some perimenopausal
women have altered estrogen levels.
8. Obese women and estradiol levels during menopause: Obese women are more
likely to have anovulatory cycles with high estradiol levels.
9. Chinese and Japanese women: These ethnic groups have lower estradiol
levels than white, black, and Hispanic women.
10. Stage +2: Late menopause stage: 5-8 years after FMP. Somatic aging
predominates.
11. Stages +1a, +1b, +1c: Early post menopause: 2 years after FMP. FSH rises,
estradiol decreases.
12. Elevated FSH, LH: Endocrine labs after menopause.
13. AMH, inhibin B: These hormones work during reproductive years to not
deplete follicle pool too quickly.
14. Phases during menopause transition and PMS symptoms: Menstrual cycle
variable, persistent >7 day difference between difference in length of
consecutive cycles.
15. How to respond if a patient requests FSH lab? Many pitfalls, variable
depending on the day of the cycle you draw the lab.
16. The potentially superior marker of menopause, a lab. AMH.
17. DHEA (dehydroepiandrosterone): Adrenal androgens: precursor hormones
produced by the adrenal gland that are enzymatically converted to active
androgens or estrogens in peripheral tissues.
18. Location of estrogen receptors: Vagina, vulva, urethra, trigone of the bladder.
, 19. Effects of estrogen on tissue: Maintain blood flow, the collagen, and HA
within the epithelial surfaces.
20. Vaginal changes with menopause: Thinning, loss of elasticity, loss or
absence of rugae.
21. Vagina and urethra in menopause: Vagina narrows, urethra moves closer to
the introitus.
22. Stress urinary incontinence: Vaginal estrogen and urinary incontinence: what
type does it help with?
23. Treatment for FPHL: Minoxidil, spironolactone, finasteride, estrogen
therapy.
24. Late reproductive years -3b and -3a: -3b: menstrual cycles normal, FSH
normal, AMH low, AFC low, inhibin low. -3a: subtle menstrual changes,
variable FSH, AMH low, AFC low, inhibin low.
25. When it is appropriate to check an FSH during the cycle if you check it? Cycle
day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH
level.
26. AFC: Antral follicle count. Number of follicles that are detectable with
ultrasound.
27. Late menopause transition (-1) FSH level on random draw: 25 or higher.
28. Black women have higher or lower FSH levels? Higher.
29. Chinese and Japanese women have higher or lower estradiol levels compared to
white, black and Hispanic women? Lower.
30. Menopause transition-changes in SHBG and testosterone? SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
31. Testosterone/SHBG ratio is called what? The free androgen index.
32. What stage is VMS more likely? +1b (generally last 2 years).
33. What hormone is generally higher in obese women? Estrone-via aromatization.
34. The postmenopausal ovary continues to produce what two
hormones? Testosterone and androstenedione.
35. Surgical menopause causes women to have lower levels of what
hormone? Testosterone. 40-50% lower than in women w/ intact ovaries.
36. Driving piece of menopause is ovarian follicles depleting. What does this do to
the inhibin B and AMH? Inhibin and AMH decrease.
37. In the menopause transition, women spend more time in what phase? Luteal-
more PMS symptoms, more frequent menstrual periods.
38. HPO axis theory and the menopause transition: It is felt that the HPO axis may
become less sensitive to estrogen.
