NAMS Menopause Certification Exam
(2026/2027) | Previously Tested
Questions | Complete Study Resource |
A+
• Climacteric phase -✓✓The period of endrocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
• Early menopause -✓✓LMP before age 45
• Late menopause -✓✓LMP after age 54
• Primary ovarian insufficiency -✓✓Menopause that occurs before age 40
• Early menopause transition (stage -2) -✓✓Persistent difference of 7 days or more in
the length of consecutive cycles.
• Late menopause transition (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.
• Obese women and estradiol levels during menopause -✓✓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 -✓✓These ethnic groups have lower estradiol levels
then white, black and hispanic women.
• stage +2 -✓✓late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
• Stages +1a, +1b, +1c -✓✓early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
• Elevated FSH, LH -✓✓Endocrine labs after menopause
,• AMH, inhibin B -✓✓These hormones work during reproductive years to not deplete
follicle pool too quickly.
• Phases during menopause transition and PMS symptoms -✓✓Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive
cycles.
• 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.
• The potentially superior marker of menopause, a lab. -✓✓AMH
• DHEA (dehydroepiandrosterone) -✓✓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 -✓✓Vagina, vulva, urethra, trigone of the bladder
• Effects of estrogen on tissue -✓✓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 -✓✓Thinning, loss of elasticity, loss or absence or
rugae.
• Vagina and urethra in menopause -✓✓vagina narrows, urethra moves 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
• Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH,
AMH, AFC, inhibin? -✓✓-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? -
✓✓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?
When does it peak? -✓✓produced by granulosa cells
used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low
ovarian reserve.
not recommended as a screening tool to predict fertility.
Peaks at around 25 years old. So before age 25, this test is not helpful.
It is influenced by exogenous hormones. Lower in hormonal contraception users, but
increases after d/cing.
• AFC -✓✓Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability pool of follicles.
• Late menopause transition (-1) FSH level on random draw -✓✓25 or higher
• Black women have higher or lower FSH levels? -✓✓Higher
• Chinese and Japanese women have higher or lower estradiol levels compared to
white, black and hispanic women? -✓✓lower
• Menopause transition-changes in SHBG and testosterone? ratio? -✓✓SHBG
decreases
Testosterone/SHBG ratio increases by 80%.
• Testosterone/SHGB ratio is called what? -✓✓The free androgen index
• What stage are VMS more likely? -✓✓+1b (generally last 2 years)
• What hormone is generally higher in obese women? -✓✓Estrone-via aromatization.
• The postmenopausal ovary continues to produce what two hormones? -
✓✓testosterone and androstenedione
• Surgical menopause causes women to have lower levels of what hormone? -
✓✓testosterone. 40-50% lower than in women w/ intact ovaries.
• Driving piece of menopause is ovarian follicles depleting. What does this do to the
inhibin B and AMH? -✓✓inhibin and AMH decrease
(2026/2027) | Previously Tested
Questions | Complete Study Resource |
A+
• Climacteric phase -✓✓The period of endrocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
• Early menopause -✓✓LMP before age 45
• Late menopause -✓✓LMP after age 54
• Primary ovarian insufficiency -✓✓Menopause that occurs before age 40
• Early menopause transition (stage -2) -✓✓Persistent difference of 7 days or more in
the length of consecutive cycles.
• Late menopause transition (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.
• Obese women and estradiol levels during menopause -✓✓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 -✓✓These ethnic groups have lower estradiol levels
then white, black and hispanic women.
• stage +2 -✓✓late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
• Stages +1a, +1b, +1c -✓✓early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
• Elevated FSH, LH -✓✓Endocrine labs after menopause
,• AMH, inhibin B -✓✓These hormones work during reproductive years to not deplete
follicle pool too quickly.
• Phases during menopause transition and PMS symptoms -✓✓Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive
cycles.
• 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.
• The potentially superior marker of menopause, a lab. -✓✓AMH
• DHEA (dehydroepiandrosterone) -✓✓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 -✓✓Vagina, vulva, urethra, trigone of the bladder
• Effects of estrogen on tissue -✓✓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 -✓✓Thinning, loss of elasticity, loss or absence or
rugae.
• Vagina and urethra in menopause -✓✓vagina narrows, urethra moves 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
• Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH,
AMH, AFC, inhibin? -✓✓-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? -
✓✓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?
When does it peak? -✓✓produced by granulosa cells
used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low
ovarian reserve.
not recommended as a screening tool to predict fertility.
Peaks at around 25 years old. So before age 25, this test is not helpful.
It is influenced by exogenous hormones. Lower in hormonal contraception users, but
increases after d/cing.
• AFC -✓✓Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability pool of follicles.
• Late menopause transition (-1) FSH level on random draw -✓✓25 or higher
• Black women have higher or lower FSH levels? -✓✓Higher
• Chinese and Japanese women have higher or lower estradiol levels compared to
white, black and hispanic women? -✓✓lower
• Menopause transition-changes in SHBG and testosterone? ratio? -✓✓SHBG
decreases
Testosterone/SHBG ratio increases by 80%.
• Testosterone/SHGB ratio is called what? -✓✓The free androgen index
• What stage are VMS more likely? -✓✓+1b (generally last 2 years)
• What hormone is generally higher in obese women? -✓✓Estrone-via aromatization.
• The postmenopausal ovary continues to produce what two hormones? -
✓✓testosterone and androstenedione
• Surgical menopause causes women to have lower levels of what hormone? -
✓✓testosterone. 40-50% lower than in women w/ intact ovaries.
• Driving piece of menopause is ovarian follicles depleting. What does this do to the
inhibin B and AMH? -✓✓inhibin and AMH decrease
