NAMS Menopause Certification | Questions and Answers | 2027 Update | Exam Review Pack

NAMS Menopause Certification | Questions and Answers | 2027 Update | Exam Review Pack Late menopause transition (-1) FSH level on random draw - ANSWER -25 or higher Black women have higher or lower FSH levels? - ANSWER -Higher Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic women? - ANSWER -lower Menopause transition-changes in SHBG and testosterone? ratio? - ANSWER SHBG decreases Testosterone/SHBG ratio increases by 80%. Testosterone/SHGB ratio is called what? - ANSWER -The free androgen index What stage are VMS more likely? - ANSWER -+1b (generally last 2 years) What hormone is generally higher in obese women? - ANSWER -Estrone-via aromatization. The postmenopausal ovary continues to produce what two hormones? - ANSWER -testosterone and androstenedione Surgical menopause causes women to have lower levels of what hormone? - ANSWER -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? - ANSWER -inhibin and AMH decrease therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished follicle pool. In the menopause transition, women spend more time in what phase? - ANSWER -Luteal-more PMS symptoms, more frequent menstrual periods. HPO axis theory and the menopause transition - ANSWER -It is felt that the HPO axis may become less sensitive to estrogen, so even with good follicle growth and estradiol secretion, LH surges can fail which can lead to more cycle irregularity. In the first year after the FMP, there is no production of what hormone? - ANSWER -progesterone What region of the adrenal gland secretes the androgens? - ANSWER -zona reticularis what are considered the 'adrenal androgens'? - ANSWER -DHEA, DHEAS, Androstenedione. Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors. - ANSWER -Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by the anterior pituitary. What part of the pituitary gland secretes adrenocorticotropic hormone? - ANSWER -Anterior pituitary. The posterior only secretes vasopressin and oxytosin. Cortisol and HRT - ANSWER -Most serum cortisol circulates bound to cortisol binding globulin. Oral estrogen increases the cortisol binding globulin, which increases total cortisol concentration. Oral tamoxifen acts similarly. Transdermal does not increase it, so it has a minimal effect on serum cortisol concentration. Do cortisol levels associate with VMS severity? - ANSWER -No, cortisol levels have NOT been associated with more severe VMS. Local DHEA has been proven to help with what? - ANSWER -vaginal pain and dyspareunia How to DX POI? - ANSWER -Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months. AND elevated FSH over 25 on two occasions at least 4 weeks apart. Anyone 40years old who misses 3+ consecutive cycles gets these labs - ANSWER -prolactin FSH estradiol TSH pregnancy test treatment of POI - ANSWER -100 microgram estradiol patch 1.25 mg CEE 2mg oral estradiol If intact uterus-progesterone for 12 days of the month. Physiologic is better than continuous hormonal contractption, but if menorrhagia IUD plus estrogen patch, or if really not wanting to risk pregnancy, continuous HRT can be used. Hair loss. Difference between FPHL and telogen effluvium? - ANSWER -FPHL is gradual, telogen effluvium is sudden and usually precipitated by a life stressor, chronic illness, beta blockers or anticoagulants-usually more patchy hair loss. FPHL pattern - ANSWER -thinning at the crown of the head and widening of the hair part Treating FPHL - ANSWER -MINOXIDIL spironolactone finasteride What ethnicity has the least likely chance of having bad hot flashes? - ANSWER Japanese What ethnicity is the most likely to have bad hot flashes? - ANSWER -black more frequent, longer duration.