NAMs MENOPAUSE CERTIFICATION
EXAM 2024-2025 ACTUAL EXAM 250
QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES (VERIFIED
ANSWERS
Climacteric phase - correct-answers>>>>The period of endrocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause - correct-answers>>>>LMP before age 45
Late menopause - correct-answers>>>>LMP after age 54
Primary ovarian insufficiency - correct-answers>>>>Menopause that occurs before age 40
Early menopause transition (stage -2) - correct-answers>>>>Persistent difference of 7 days or more
in the length of consecutive cycles.
Late menopause transition (stage -1) - correct-answers>>>>60 or more consecutive days of
amenorrhea
,Luteal out of phase event (LOOP) - correct-answers>>>>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 - correct-answers>>>>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 - correct-answers>>>>These ethnic groups have lower estradiol
levels then white, black and hispanic women.
stage +2 - correct-answers>>>>late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - correct-answers>>>>early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
Elevated FSH, LH - correct-answers>>>>Endocrine labs after menopause
,AMH, inhibin B - correct-answers>>>>These hormones work during reproductive years to not deplete
follicle pool too quickly.
Phases during menopause transition and PMS symptoms - correct-answers>>>>Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? - correct-answers>>>>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. - correct-answers>>>>AMH
DHEA (dehydroepiandrosterone) - correct-answers>>>>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 - correct-answers>>>>Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - correct-answers>>>>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 - correct-answers>>>>Thinning, loss of elasticity, loss or absence
or rugae.
Vagina and urethra in menopause - correct-answers>>>>vagina narrows, urethra moves closer to
the introitus.
Stress urinary incontinence - correct-answers>>>>Vaginal estrogen and urinary incontinence: what
type does it help with?
Treatment for FPHL - correct-answers>>>>Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin?
- correct-answers>>>>-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? - correct-
answers>>>>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?
EXAM 2024-2025 ACTUAL EXAM 250
QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES (VERIFIED
ANSWERS
Climacteric phase - correct-answers>>>>The period of endrocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause - correct-answers>>>>LMP before age 45
Late menopause - correct-answers>>>>LMP after age 54
Primary ovarian insufficiency - correct-answers>>>>Menopause that occurs before age 40
Early menopause transition (stage -2) - correct-answers>>>>Persistent difference of 7 days or more
in the length of consecutive cycles.
Late menopause transition (stage -1) - correct-answers>>>>60 or more consecutive days of
amenorrhea
,Luteal out of phase event (LOOP) - correct-answers>>>>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 - correct-answers>>>>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 - correct-answers>>>>These ethnic groups have lower estradiol
levels then white, black and hispanic women.
stage +2 - correct-answers>>>>late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - correct-answers>>>>early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
Elevated FSH, LH - correct-answers>>>>Endocrine labs after menopause
,AMH, inhibin B - correct-answers>>>>These hormones work during reproductive years to not deplete
follicle pool too quickly.
Phases during menopause transition and PMS symptoms - correct-answers>>>>Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? - correct-answers>>>>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. - correct-answers>>>>AMH
DHEA (dehydroepiandrosterone) - correct-answers>>>>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 - correct-answers>>>>Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - correct-answers>>>>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 - correct-answers>>>>Thinning, loss of elasticity, loss or absence
or rugae.
Vagina and urethra in menopause - correct-answers>>>>vagina narrows, urethra moves closer to
the introitus.
Stress urinary incontinence - correct-answers>>>>Vaginal estrogen and urinary incontinence: what
type does it help with?
Treatment for FPHL - correct-answers>>>>Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin?
- correct-answers>>>>-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? - correct-
answers>>>>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?
