NAMS MENOPAUSE CERTIFICATION
EXAM 2025 ACTUAL EXAM 270
QUESTIONS WITH DETAILED VERIFIED
ANSWERS ALREADY GRADED A+
LATEST VERSION
"List the vaginal changes with menopause you might note on clinical/microscopic exam. -
CORRECT ANSWER=> Thinning of the epithelial layer,
loss of elasticity with
narrowing of the canal and
poor distention, noted on pelvic exam with
loss or absence of rugae.
Due to the decrease in glycogen content, the lactobacilli are decreased resulting in higher pH."
"List the vulvar and urethral changes in menopause. - CORRECT ANSWER=> Thinning of the
epithelial layers and vagina narrowing leads the urethra moves closer to the introitus."
"Stress urinary incontinence - CORRECT ANSWER=> Vaginal estrogen and urinary incontinence:
what type does it help with?"
"Treatment for FPHL - CORRECT ANSWER=> Minoxidil, spironolactone, finasteride, estrogen
therapy"
"Late reproductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC,
inhibin? - CORRECT 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? why? - CORRECT
ANSWER=> Cycle day #3.
Page | 1
,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? - CORRECT 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."
"What does AFC stand for? What is considered a normal value? - CORRECT ANSWER=> Antral
Follicle Count
> 12 follicles detectable with ultrasound is considered normal"
"What is the significance of antral follicle count? - CORRECT ANSWER=> The ability of the ovaries
to respond. It can represent the number of follicles detectable with ultrasound. It is sensitive to
FSH, and represents the available pool of follicles."
"What is the FSH level on a random draw in Late menopause transition (STRAW Stage: -1)? -
CORRECT ANSWER=> >/= 25 IU/L"
"Black women have higher or lower FSH levels? - CORRECT ANSWER=> Higher"
"Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and hispanic women? - CORRECT ANSWER=> Lower"
"What happens to SHBG during menopause?
How does that effect the free androgen index? - CORRECT ANSWER=> SHBG decreases.
Testosterone/SHBG ratio increases by 80%."
Page | 2
, "Testosterone:SHGB ratio is called what? - CORRECT ANSWER=> The free androgen index"
"What stage are VMS more likely? - CORRECT ANSWER=> +1a, 1b"
"What hormone is generally higher in obese women? - CORRECT ANSWER=> Estrone-via
aromatization."
"The postmenopausal ovary continues to produce what two hormones? - CORRECT ANSWER=>
testosterone and androstenedione"
"Surgical menopause causes women to have lower levels of what hormone? - CORRECT
ANSWER=> Testosterone. 40-50% lower than in women w/ intact ovaries."
"Driving pace of menopause is ovarian follicles depleting. What does this do to the inhibin B and
AMH? What does that do to FSH? - CORRECT ANSWER=> Inhibin B and AMH decrease.
Decreased InhB leads to unrestrained FSH. This allows for the growth of the remaining,
diminished follicle pool (shortened follicular phase). Increased atresia. Occasional LOOP cycles."
"In the menopause transition, women spend more time in what menstrual phase? - CORRECT
ANSWER=> Luteal-more PMS symptoms, more frequent menstrual periods."
"HPO axis theory and the menopause transition - CORRECT ANSWER=> 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? - CORRECT ANSWER=>
progesterone"
"What region of the adrenal gland secretes the androgens? - CORRECT ANSWER=> zona
reticularis"
"What are considered the 'adrenal androgens'? - CORRECT ANSWER=> Precursor hormones
produced by the adrenal gland, which are enzymatically converted to active
androgens/estrogens in peripheral tissue.
Dehydroepiandrosterone DHEA
Dehydroepiandrosterone-sulfate DHEAS
Page | 3
EXAM 2025 ACTUAL EXAM 270
QUESTIONS WITH DETAILED VERIFIED
ANSWERS ALREADY GRADED A+
LATEST VERSION
"List the vaginal changes with menopause you might note on clinical/microscopic exam. -
CORRECT ANSWER=> Thinning of the epithelial layer,
loss of elasticity with
narrowing of the canal and
poor distention, noted on pelvic exam with
loss or absence of rugae.
Due to the decrease in glycogen content, the lactobacilli are decreased resulting in higher pH."
"List the vulvar and urethral changes in menopause. - CORRECT ANSWER=> Thinning of the
epithelial layers and vagina narrowing leads the urethra moves closer to the introitus."
"Stress urinary incontinence - CORRECT ANSWER=> Vaginal estrogen and urinary incontinence:
what type does it help with?"
"Treatment for FPHL - CORRECT ANSWER=> Minoxidil, spironolactone, finasteride, estrogen
therapy"
"Late reproductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC,
inhibin? - CORRECT 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? why? - CORRECT
ANSWER=> Cycle day #3.
Page | 1
,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? - CORRECT 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."
"What does AFC stand for? What is considered a normal value? - CORRECT ANSWER=> Antral
Follicle Count
> 12 follicles detectable with ultrasound is considered normal"
"What is the significance of antral follicle count? - CORRECT ANSWER=> The ability of the ovaries
to respond. It can represent the number of follicles detectable with ultrasound. It is sensitive to
FSH, and represents the available pool of follicles."
"What is the FSH level on a random draw in Late menopause transition (STRAW Stage: -1)? -
CORRECT ANSWER=> >/= 25 IU/L"
"Black women have higher or lower FSH levels? - CORRECT ANSWER=> Higher"
"Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and hispanic women? - CORRECT ANSWER=> Lower"
"What happens to SHBG during menopause?
How does that effect the free androgen index? - CORRECT ANSWER=> SHBG decreases.
Testosterone/SHBG ratio increases by 80%."
Page | 2
, "Testosterone:SHGB ratio is called what? - CORRECT ANSWER=> The free androgen index"
"What stage are VMS more likely? - CORRECT ANSWER=> +1a, 1b"
"What hormone is generally higher in obese women? - CORRECT ANSWER=> Estrone-via
aromatization."
"The postmenopausal ovary continues to produce what two hormones? - CORRECT ANSWER=>
testosterone and androstenedione"
"Surgical menopause causes women to have lower levels of what hormone? - CORRECT
ANSWER=> Testosterone. 40-50% lower than in women w/ intact ovaries."
"Driving pace of menopause is ovarian follicles depleting. What does this do to the inhibin B and
AMH? What does that do to FSH? - CORRECT ANSWER=> Inhibin B and AMH decrease.
Decreased InhB leads to unrestrained FSH. This allows for the growth of the remaining,
diminished follicle pool (shortened follicular phase). Increased atresia. Occasional LOOP cycles."
"In the menopause transition, women spend more time in what menstrual phase? - CORRECT
ANSWER=> Luteal-more PMS symptoms, more frequent menstrual periods."
"HPO axis theory and the menopause transition - CORRECT ANSWER=> 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? - CORRECT ANSWER=>
progesterone"
"What region of the adrenal gland secretes the androgens? - CORRECT ANSWER=> zona
reticularis"
"What are considered the 'adrenal androgens'? - CORRECT ANSWER=> Precursor hormones
produced by the adrenal gland, which are enzymatically converted to active
androgens/estrogens in peripheral tissue.
Dehydroepiandrosterone DHEA
Dehydroepiandrosterone-sulfate DHEAS
Page | 3
