NAMs Menopause Certification Exam
2026 Questions and Answers
Climacteric phase - Correct answer-The period of endrocrinologic, somatic, and
transitory psychologic changes that occur around the time of menopause.
Early menopause - Correct answer-LMP before age 45
Late menopause - Correct answer-LMP after age 54
Primary ovarian insufficiency - Correct answer-Menopause that occurs before age
40
Early menopause transition (stage -2) - Correct answer-Persistent difference of 7
days or more in the length of consecutive cycles.
Late menopause transition (stage -1) - Correct answer-60 or more consecutive days
of amenorrhea
Luteal out of phase event (LOOP) - Correct answer-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
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,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 answer-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 answer-These ethnic groups have lower
estradiol levels then white, black and hispanic women.
stage +2 - Correct answer-late menopause stage: 5-8 years after FMP. Somatic
aging predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - Correct answer-early post menopause: 2 years after FMP.
FSH rises, estradiol decreases. VMS predominate.
Elevated FSH, LH - Correct answer-Endocrine labs after menopause
AMH, inhibin B - Correct answer-These hormones work during reproductive years
to not deplete follicle pool too quickly.
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, Phases during menopause transition and PMS symptoms - Correct answer-
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? - Correct answer-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 answer-AMH
DHEA (dehydroepiandrosterone) - Correct answer-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 answer-Vagina, vulva, urethra, trigone of
the bladder
Effects of estrogen on tissue - Correct answer-maintain blood flow, the collagen,
and HA within the epithelial surfaces. Supports microbiome and protects tissue
from pathogens.
Vaginal changes with menopause - Correct answer-Thinning, loss of elasticity, loss
or absence or rugae.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 3
2026 Questions and Answers
Climacteric phase - Correct answer-The period of endrocrinologic, somatic, and
transitory psychologic changes that occur around the time of menopause.
Early menopause - Correct answer-LMP before age 45
Late menopause - Correct answer-LMP after age 54
Primary ovarian insufficiency - Correct answer-Menopause that occurs before age
40
Early menopause transition (stage -2) - Correct answer-Persistent difference of 7
days or more in the length of consecutive cycles.
Late menopause transition (stage -1) - Correct answer-60 or more consecutive days
of amenorrhea
Luteal out of phase event (LOOP) - Correct answer-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
©COPYRIGHT 2025, ALL RIGHTS RESERVED 1
,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 answer-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 answer-These ethnic groups have lower
estradiol levels then white, black and hispanic women.
stage +2 - Correct answer-late menopause stage: 5-8 years after FMP. Somatic
aging predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - Correct answer-early post menopause: 2 years after FMP.
FSH rises, estradiol decreases. VMS predominate.
Elevated FSH, LH - Correct answer-Endocrine labs after menopause
AMH, inhibin B - Correct answer-These hormones work during reproductive years
to not deplete follicle pool too quickly.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
, Phases during menopause transition and PMS symptoms - Correct answer-
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? - Correct answer-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 answer-AMH
DHEA (dehydroepiandrosterone) - Correct answer-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 answer-Vagina, vulva, urethra, trigone of
the bladder
Effects of estrogen on tissue - Correct answer-maintain blood flow, the collagen,
and HA within the epithelial surfaces. Supports microbiome and protects tissue
from pathogens.
Vaginal changes with menopause - Correct answer-Thinning, loss of elasticity, loss
or absence or rugae.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 3
