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NAMs Menopause Certification Exam LATEST UPDATED EXAM VERSION
WITH VERIFIED EXPERT ANSWERS 100% GUARANTEED PASS
The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of
menopause.
Climacteric phase
LMP before age 45
Early menopause
LMP after age 54
Late menopause
Menopause that occurs before age 40
Primary ovarian insufficiency
Persistent difference of 7 days or more in the length of consecutive cycles.
Early menopause transition (stage -2)
60 or more consecutive days of amenorrhea
Late menopause transition (stage -1)
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.
Luteal out of phase event (LOOP)
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)
Obese women and estradiol levels during menopause
These ethnic groups have lower estradiol levels then white, black and hispanic women.
Chinese and Japanese women
late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary symptoms.
stage +2
early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate.
Stages +1a, +1b, +1c
Endocrine labs after menopause
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Elevated FSH, LH
These hormones work during reproductive years to not deplete follicle pool too quickly.
AMH, inhibin B
Menstrual cycle variable, persistent >7 day difference between difference in length of consecutive cycles.
Phases during menopause transition and PMS symptoms
many pitfalls, variable depending on the day of the cycle you draw the lab, normal or low FSH is not helpful.
How to respond if a patient requests FSH lab?
AMH
The potentially superior marker of menopause, a lab.
Adrenal androgens: precursor hromones produced by the adrenal gland that are enzymatically converted to
active androgens or estrogens in peripheral tissues.
DHEA (dehydroepiandrosterone)
Vagina, vulva, urethra, trigone of the bladder
Location of estrogen receptors
maintain blood flow, the collagen, and HA within the epithelial surfaces. Supports microbiome which supports
acidity of vagina and protects tissue from pathogens.
Effects of estrogen on tissue
Thinning, loss of elasticity, loss or absence or rugae.
Vaginal changes with menopause
vagina narrows, urethra moves closer to the introitus.
Vagina and urethra in menopause
Vaginal estrogen and urinary incontinence: what type does it help with?
Stress urinary incontinence
Minoxidil, spironolactone, finasteride, estrogen therapy
Treatment for FPHL
-3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low.
-3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low.
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin?
Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
,3|Page
When it is appropriate to check an FSH during the cycle if you check it? and why?
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.
AMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak?
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.
AFC
25 or higher
Late menopause transition (-1) FSH level on random draw
Higher
Black women have higher or lower FSH levels?
lower
Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic
women?
SHBG decreases
Testosterone/SHBG ratio increases by 80%.
Menopause transition-changes in SHBG and testosterone? ratio?
The free androgen index
Testosterone/SHGB ratio is called what?
+1b (generally last 2 years)
What stage are VMS more likely?
Estrone-via aromatization.
, 4|Page
What hormone is generally higher in obese women?
testosterone and androstenedione
The postmenopausal ovary continues to produce what two hormones?
testosterone. 40-50% lower than in women w/ intact ovaries.
Surgical menopause causes women to have lower levels of what hormone?
inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished follicle pool.
Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B and AMH?
Luteal-more PMS symptoms, more frequent menstrual periods.
In the menopause transition, women spend more time in what phase?
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.
HPO axis theory and the menopause transition
progesterone
In the first year after the FMP, there is no production of what hormone?
zona reticularis
What region of the adrenal gland secretes the androgens?
DHEA, DHEAS, Androstenedione.
what are considered the 'adrenal androgens'?
Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by the anterior pituitary.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors.
Anterior pituitary. The posterior only secretes vasopressin and oxytosin.
What part of the pituitary gland secretes adrenocorticotropic hormone?
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.
Cortisol and HRT
NAMs Menopause Certification Exam LATEST UPDATED EXAM VERSION
WITH VERIFIED EXPERT ANSWERS 100% GUARANTEED PASS
The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of
menopause.
Climacteric phase
LMP before age 45
Early menopause
LMP after age 54
Late menopause
Menopause that occurs before age 40
Primary ovarian insufficiency
Persistent difference of 7 days or more in the length of consecutive cycles.
Early menopause transition (stage -2)
60 or more consecutive days of amenorrhea
Late menopause transition (stage -1)
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.
Luteal out of phase event (LOOP)
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)
Obese women and estradiol levels during menopause
These ethnic groups have lower estradiol levels then white, black and hispanic women.
Chinese and Japanese women
late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary symptoms.
stage +2
early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate.
Stages +1a, +1b, +1c
Endocrine labs after menopause
,2|Page
Elevated FSH, LH
These hormones work during reproductive years to not deplete follicle pool too quickly.
AMH, inhibin B
Menstrual cycle variable, persistent >7 day difference between difference in length of consecutive cycles.
Phases during menopause transition and PMS symptoms
many pitfalls, variable depending on the day of the cycle you draw the lab, normal or low FSH is not helpful.
How to respond if a patient requests FSH lab?
AMH
The potentially superior marker of menopause, a lab.
Adrenal androgens: precursor hromones produced by the adrenal gland that are enzymatically converted to
active androgens or estrogens in peripheral tissues.
DHEA (dehydroepiandrosterone)
Vagina, vulva, urethra, trigone of the bladder
Location of estrogen receptors
maintain blood flow, the collagen, and HA within the epithelial surfaces. Supports microbiome which supports
acidity of vagina and protects tissue from pathogens.
Effects of estrogen on tissue
Thinning, loss of elasticity, loss or absence or rugae.
Vaginal changes with menopause
vagina narrows, urethra moves closer to the introitus.
Vagina and urethra in menopause
Vaginal estrogen and urinary incontinence: what type does it help with?
Stress urinary incontinence
Minoxidil, spironolactone, finasteride, estrogen therapy
Treatment for FPHL
-3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low.
-3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low.
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin?
Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
,3|Page
When it is appropriate to check an FSH during the cycle if you check it? and why?
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.
AMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak?
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.
AFC
25 or higher
Late menopause transition (-1) FSH level on random draw
Higher
Black women have higher or lower FSH levels?
lower
Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic
women?
SHBG decreases
Testosterone/SHBG ratio increases by 80%.
Menopause transition-changes in SHBG and testosterone? ratio?
The free androgen index
Testosterone/SHGB ratio is called what?
+1b (generally last 2 years)
What stage are VMS more likely?
Estrone-via aromatization.
, 4|Page
What hormone is generally higher in obese women?
testosterone and androstenedione
The postmenopausal ovary continues to produce what two hormones?
testosterone. 40-50% lower than in women w/ intact ovaries.
Surgical menopause causes women to have lower levels of what hormone?
inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished follicle pool.
Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B and AMH?
Luteal-more PMS symptoms, more frequent menstrual periods.
In the menopause transition, women spend more time in what phase?
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.
HPO axis theory and the menopause transition
progesterone
In the first year after the FMP, there is no production of what hormone?
zona reticularis
What region of the adrenal gland secretes the androgens?
DHEA, DHEAS, Androstenedione.
what are considered the 'adrenal androgens'?
Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by the anterior pituitary.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors.
Anterior pituitary. The posterior only secretes vasopressin and oxytosin.
What part of the pituitary gland secretes adrenocorticotropic hormone?
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.
Cortisol and HRT
