2025 NAMS MENOPAUSE
CERTIFICATION EXAM QUESTIONS
WITH ANSWERS
,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
CERTIFICATION EXAM QUESTIONS
WITH ANSWERS
,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
