NAMS MENOPAUSE CERTIFICATION EXAM
PREP 2026 SOLVED QUESTIONS ANSWERS
GRADED A PLUS REPRODUCTIVE HEALTH
HANDBOOK
◉ 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 levels sometimes.
◉ Obese women and estradiol levels during menopause.
Answer: Obese women are more likely to have anovulatory cycles
with high estradiol levels.
◉ Chinese and Japanese women.
Answer: These ethnic groups have lower estradiol levels than white,
black, and Hispanic women.
◉ Stage +2.
Answer: Late menopause stage: 5-8 years after FMP. Somatic aging
predominates.
◉ Stages +1a, +1b, +1c.
Answer: Early post menopause: 2 years after FMP. FSH rises,
estradiol decreases.
◉ 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.
◉ The potentially superior marker of menopause, a lab..
Answer: AMH.
◉ DHEA (dehydroepiandrosterone).
Answer: Adrenal androgens: precursor hormones 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.
◉ Vaginal changes with menopause.
Answer: Thinning, loss of elasticity, loss or absence of 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 reproductive years -3b and -3a.
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.
PREP 2026 SOLVED QUESTIONS ANSWERS
GRADED A PLUS REPRODUCTIVE HEALTH
HANDBOOK
◉ 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 levels sometimes.
◉ Obese women and estradiol levels during menopause.
Answer: Obese women are more likely to have anovulatory cycles
with high estradiol levels.
◉ Chinese and Japanese women.
Answer: These ethnic groups have lower estradiol levels than white,
black, and Hispanic women.
◉ Stage +2.
Answer: Late menopause stage: 5-8 years after FMP. Somatic aging
predominates.
◉ Stages +1a, +1b, +1c.
Answer: Early post menopause: 2 years after FMP. FSH rises,
estradiol decreases.
◉ 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.
◉ The potentially superior marker of menopause, a lab..
Answer: AMH.
◉ DHEA (dehydroepiandrosterone).
Answer: Adrenal androgens: precursor hormones 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.
◉ Vaginal changes with menopause.
Answer: Thinning, loss of elasticity, loss or absence of 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 reproductive years -3b and -3a.
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.
