NAMS Menopause Certification Exam – Questions and
Answers (Graded A+) 2025/2026
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 shortenes,
follicular phase compresses, women spend more time in luteal phase.. meaning more
premenstrual symptoms and more frequent menstrual periods.
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 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?
Answers (Graded A+) 2025/2026
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 shortenes,
follicular phase compresses, women spend more time in luteal phase.. meaning more
premenstrual symptoms and more frequent menstrual periods.
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 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?
