1
NAMS CERTIFICATE EXAM 2022 QUESTIONS AND VERIFIED
ANSWERS GUARANTEED SUCCESS
POI Management
HT until average of menopause
Early Menopause Risks (natural or surgical)
- CVD
- Low bone density
- Memory for verbal information compromised
- Low libido due to decreased testosterone
- Depression due to fertility
LOOP Cycles
Explains elevation of Estradiol in perimenopause
- Rising FSH levels recruit 2nd follicle during luteal phase which leads to
overproduction of Estradiol
- This causes menstrual changes in future cycles
Decreased AMH in Early Menopause Transition
More frequent anovulatory cycles
Decreased Inhibin B in Early Menopause Transition
- Skipped menstrual cycles
- Mastalgia
- Migraine
, 2
- Menorrhagia (with LOOP cycles)
- Endometrial Hyperplasia
Late Menopause Transition (-1)
60 or more days of amenorrhea for women aged 45 years or older
- Women 40-44 years with recurrent episodes of amenorrhea of 60 day for longer
within a year improves prediction of entry into late menopause transition
Late Menopause Transition (-1) Duration
1-3 years
Late Menopause Transition (-1) Symptoms
VMS likely
STRAW Stage where FSH > 25
Late Menopause Transition (-1)
Elevated FSH symptoms in Late Menopause Transition
- VMS
- Sleep disturbance
- Changes in weight distribution
- Increased variability in cycle length
Decreased Inhibin B in Late Menopause Transition
- Mood changes
- Cognitive complaints
- Changes in sexual functioning
- Increased prevalence of anovulation
Ovarian Reserve Lab
, 3
- Antral follicle count & AMH
Secondary Amenorrhea differential with low FSH
- Pregnancy
- Hypothalamic amenorrhea (e.g., Diabetes, celiac disease, excessive
exercise/caloric restriction, stress, lesions of hypothalamus/pituitary)
- Hyperprolactinemia
- Thyroid disease
- PCOS
Adrenal Insufficiency
- Hypofunction of adrenal gland and pituitary gland
- Diagnosed by low cortisol at baseline
- Treatment includes glucocorticoid replacement
Female Pattern Hair Loss (FPHL)
- Gradual hair thinning on crown of scalp
- Occurs due to altered estrogen-to-androgen ratio
- Sometimes seen with discontinuation of HT
Window of Vulnerability
Idea that women are exposed to hormone-related mood symptoms (e.g., PMS,
PPD)
HT and Mood
- Consider if VMS and mood changes
- Only consider if in perimenopause or early postmenopausal
Early Postmenopause (+1a/+1b)
- Duration is 2 years
NAMS CERTIFICATE EXAM 2022 QUESTIONS AND VERIFIED
ANSWERS GUARANTEED SUCCESS
POI Management
HT until average of menopause
Early Menopause Risks (natural or surgical)
- CVD
- Low bone density
- Memory for verbal information compromised
- Low libido due to decreased testosterone
- Depression due to fertility
LOOP Cycles
Explains elevation of Estradiol in perimenopause
- Rising FSH levels recruit 2nd follicle during luteal phase which leads to
overproduction of Estradiol
- This causes menstrual changes in future cycles
Decreased AMH in Early Menopause Transition
More frequent anovulatory cycles
Decreased Inhibin B in Early Menopause Transition
- Skipped menstrual cycles
- Mastalgia
- Migraine
, 2
- Menorrhagia (with LOOP cycles)
- Endometrial Hyperplasia
Late Menopause Transition (-1)
60 or more days of amenorrhea for women aged 45 years or older
- Women 40-44 years with recurrent episodes of amenorrhea of 60 day for longer
within a year improves prediction of entry into late menopause transition
Late Menopause Transition (-1) Duration
1-3 years
Late Menopause Transition (-1) Symptoms
VMS likely
STRAW Stage where FSH > 25
Late Menopause Transition (-1)
Elevated FSH symptoms in Late Menopause Transition
- VMS
- Sleep disturbance
- Changes in weight distribution
- Increased variability in cycle length
Decreased Inhibin B in Late Menopause Transition
- Mood changes
- Cognitive complaints
- Changes in sexual functioning
- Increased prevalence of anovulation
Ovarian Reserve Lab
, 3
- Antral follicle count & AMH
Secondary Amenorrhea differential with low FSH
- Pregnancy
- Hypothalamic amenorrhea (e.g., Diabetes, celiac disease, excessive
exercise/caloric restriction, stress, lesions of hypothalamus/pituitary)
- Hyperprolactinemia
- Thyroid disease
- PCOS
Adrenal Insufficiency
- Hypofunction of adrenal gland and pituitary gland
- Diagnosed by low cortisol at baseline
- Treatment includes glucocorticoid replacement
Female Pattern Hair Loss (FPHL)
- Gradual hair thinning on crown of scalp
- Occurs due to altered estrogen-to-androgen ratio
- Sometimes seen with discontinuation of HT
Window of Vulnerability
Idea that women are exposed to hormone-related mood symptoms (e.g., PMS,
PPD)
HT and Mood
- Consider if VMS and mood changes
- Only consider if in perimenopause or early postmenopausal
Early Postmenopause (+1a/+1b)
- Duration is 2 years
