NAMS MENOPAUSE CERTIFICATION EXAM
2024 QUESTIONS & VERIFIED ANSWERS
GRADED A
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 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, 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 which supports acidity of
vagina 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.
, When it is appropriate to check an FSH during the cycle if you check it? and why?
- ANSWER-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? - ANSWER-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 - ANSWER-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 - ANSWER-25 or
higher
2024 QUESTIONS & VERIFIED ANSWERS
GRADED A
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 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, 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 which supports acidity of
vagina 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.
, When it is appropriate to check an FSH during the cycle if you check it? and why?
- ANSWER-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? - ANSWER-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 - ANSWER-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 - ANSWER-25 or
higher
