NAMs Menopause Certification Exam
ACTUAL QUESTIONS AND CORRECT
ANSWERS
The period of endrocrinologic, somatic, and transitory psychologic changes that occur around
the time of menopause. - CORRECT ANSWERS✅✅Climacteric phase
LMP before age 45 - CORRECT ANSWERS✅✅Early menopause
LMP after age 54 - CORRECT ANSWERS✅✅Late menopause
Menopause that occurs before age 40 - CORRECT ANSWERS✅✅Primary ovarian
insufficiency
Persistent difference of 7 days or more in the length of consecutive cycles. - CORRECT
ANSWERS✅✅Early menopause transition (stage -2)
60 or more consecutive days of amenorrhea - CORRECT ANSWERS✅✅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. - CORRECT ANSWERS✅✅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)
- CORRECT ANSWERS✅✅Obese women and estradiol levels during menopause
These ethnic groups have lower estradiol levels then white, black and hispanic women. -
CORRECT ANSWERS✅✅Chinese and Japanese women
,late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased
genitourinary symptoms. - CORRECT ANSWERS✅✅stage +2
early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate. -
CORRECT ANSWERS✅✅Stages +1a, +1b, +1c
Endocrine labs after menopause - CORRECT ANSWERS✅✅Elevated FSH, LH
These hormones work during reproductive years to not deplete follicle pool too quickly. -
CORRECT ANSWERS✅✅AMH, inhibin B
Menstrual cycle variable, persistent >7 day difference between difference in length of
consecutive cycles. - CORRECT ANSWERS✅✅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. - CORRECT ANSWERS✅✅How to respond if a patient requests FSH
lab?
AMH - CORRECT ANSWERS✅✅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. - CORRECT
ANSWERS✅✅DHEA (dehydroepiandrosterone)
Vagina, vulva, urethra, trigone of the bladder - CORRECT ANSWERS✅✅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. -
CORRECT ANSWERS✅✅Effects of estrogen on tissue
,Thinning, loss of elasticity, loss or absence or rugae. - CORRECT ANSWERS✅✅Vaginal
changes with menopause
vagina narrows, urethra moves closer to the introitus. - CORRECT ANSWERS✅✅Vagina
and urethra in menopause
Vaginal estrogen and urinary incontinence: what type does it help with? - CORRECT
ANSWERS✅✅Stress urinary incontinence
Minoxidil, spironolactone, finasteride, estrogen therapy - CORRECT
ANSWERS✅✅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. - CORRECT
ANSWERS✅✅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. -
CORRECT ANSWERS✅✅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. - CORRECT ANSWERS✅✅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. -
CORRECT ANSWERS✅✅AFC
25 or higher - CORRECT ANSWERS✅✅Late menopause transition (-1) FSH level on
random draw
Higher - CORRECT ANSWERS✅✅Black women have higher or lower FSH levels?
lower - CORRECT ANSWERS✅✅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%. - CORRECT ANSWERS✅✅Menopause
transition-changes in SHBG and testosterone? ratio?
The free androgen index - CORRECT ANSWERS✅✅Testosterone/SHGB ratio is called
what?
+1b (generally last 2 years) - CORRECT ANSWERS✅✅What stage are VMS more likely?
Estrone-via aromatization. - CORRECT ANSWERS✅✅What hormone is generally higher
in obese women?
testosterone and androstenedione - CORRECT ANSWERS✅✅The postmenopausal ovary
continues to produce what two hormones?
ACTUAL QUESTIONS AND CORRECT
ANSWERS
The period of endrocrinologic, somatic, and transitory psychologic changes that occur around
the time of menopause. - CORRECT ANSWERS✅✅Climacteric phase
LMP before age 45 - CORRECT ANSWERS✅✅Early menopause
LMP after age 54 - CORRECT ANSWERS✅✅Late menopause
Menopause that occurs before age 40 - CORRECT ANSWERS✅✅Primary ovarian
insufficiency
Persistent difference of 7 days or more in the length of consecutive cycles. - CORRECT
ANSWERS✅✅Early menopause transition (stage -2)
60 or more consecutive days of amenorrhea - CORRECT ANSWERS✅✅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. - CORRECT ANSWERS✅✅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)
- CORRECT ANSWERS✅✅Obese women and estradiol levels during menopause
These ethnic groups have lower estradiol levels then white, black and hispanic women. -
CORRECT ANSWERS✅✅Chinese and Japanese women
,late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased
genitourinary symptoms. - CORRECT ANSWERS✅✅stage +2
early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate. -
CORRECT ANSWERS✅✅Stages +1a, +1b, +1c
Endocrine labs after menopause - CORRECT ANSWERS✅✅Elevated FSH, LH
These hormones work during reproductive years to not deplete follicle pool too quickly. -
CORRECT ANSWERS✅✅AMH, inhibin B
Menstrual cycle variable, persistent >7 day difference between difference in length of
consecutive cycles. - CORRECT ANSWERS✅✅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. - CORRECT ANSWERS✅✅How to respond if a patient requests FSH
lab?
AMH - CORRECT ANSWERS✅✅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. - CORRECT
ANSWERS✅✅DHEA (dehydroepiandrosterone)
Vagina, vulva, urethra, trigone of the bladder - CORRECT ANSWERS✅✅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. -
CORRECT ANSWERS✅✅Effects of estrogen on tissue
,Thinning, loss of elasticity, loss or absence or rugae. - CORRECT ANSWERS✅✅Vaginal
changes with menopause
vagina narrows, urethra moves closer to the introitus. - CORRECT ANSWERS✅✅Vagina
and urethra in menopause
Vaginal estrogen and urinary incontinence: what type does it help with? - CORRECT
ANSWERS✅✅Stress urinary incontinence
Minoxidil, spironolactone, finasteride, estrogen therapy - CORRECT
ANSWERS✅✅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. - CORRECT
ANSWERS✅✅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. -
CORRECT ANSWERS✅✅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. - CORRECT ANSWERS✅✅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. -
CORRECT ANSWERS✅✅AFC
25 or higher - CORRECT ANSWERS✅✅Late menopause transition (-1) FSH level on
random draw
Higher - CORRECT ANSWERS✅✅Black women have higher or lower FSH levels?
lower - CORRECT ANSWERS✅✅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%. - CORRECT ANSWERS✅✅Menopause
transition-changes in SHBG and testosterone? ratio?
The free androgen index - CORRECT ANSWERS✅✅Testosterone/SHGB ratio is called
what?
+1b (generally last 2 years) - CORRECT ANSWERS✅✅What stage are VMS more likely?
Estrone-via aromatization. - CORRECT ANSWERS✅✅What hormone is generally higher
in obese women?
testosterone and androstenedione - CORRECT ANSWERS✅✅The postmenopausal ovary
continues to produce what two hormones?
