1
NAMs
NAMs Menopause Certification Exam
Questions with Correct Verified
Answers Latest Update (2026/2027)
Guaranteed Pass
1. Menopause transition-changes in SHBG and testosterone? Ratio?
- ANS ✓SHBG decreases
Testosterone/SHBG ratio increases by 80%.
2. Testosterone/SHGB ratio is called what? - ANS ✓The free
androgen index
3. What stage are VMS more likely? - ANS ✓+1b (generally last 2
years)
4. What hormone is generally higher in obese women? - ANS
✓ Estrone-via aromatization.
5. The postmenopausal ovary continues to produce what two
hormones? - ANS ✓testosterone and androstenedione
6. Surgical menopause causes women to have lower levels of what
hormone? - ANS ✓testosterone. 40-50% lower than in women w/
intact ovaries.
NAMs Menopause Certification
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7. Driving piece of menopause is ovarian follicles depleting. What
does this do to the inhibin B and AMH? - ANS ✓inhibin and AMH
decrease
Therefore, follicle growth is not restrained, this allows for the growth of the
remaining, diminished follicle pool.
8. In the menopause transition, women spend more time in what
phase? - ANS ✓Luteal-more PMS symptoms, more frequent
menstrual periods.
9. HPO axis theory and the menopause transition - ANS ✓It is felt
that the HPO axis may become less sensitive to estrogen, so even with
good follicle growth and estradiol secretion, LH surges can fail which
can lead to more cycle irregularity.
10. In the first year after the FMP, there is no production of
what hormone? - ANS ✓progesterone
11. What region of the adrenal gland secretes the androgens? -
ANS ✓zona reticularis
12. What are considered the 'adrenal androgens'? - ANS
✓ DHEA, DHEAS, Androstenedione.
13. Aldosterone secretion from the zona reticularis in the
adrenal gland is regulated by 3 main factors. - ANS ✓Angiotensin
II, potassium concentration, adrenocorticotropic hormone secreted
by the anterior pituitary.
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14. What part of the pituitary gland secretes
adrenocorticotropic hormone? - ANS ✓Anterior pituitary. The
posterior only secretes vasopressin and oxytocin.
15. Cortisol and HRT - ANS ✓Most serum cortisol circulates
bound to cortisol binding globulin.
Oral estrogen increases the cortisol binding globulin, which increases total
cortisol concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum
cortisol concentration.
16. Do cortisol levels associate with VMS severity? - ANS ✓No,
cortisol levels have NOT been associated with more severe VMS.
17. Local DHEA has been proven to help with what? - ANS
✓ vaginal pain and dyspareunia
18. How to DX POI? - ANS ✓Menstrual disturbance-
oligomenorrhea or amenorrhea for at least 4 months.
AND
Elevated FSH over 25 on two occasions at least 4 weeks apart.
NAMs Menopause Certification
NAMs
NAMs Menopause Certification Exam
Questions with Correct Verified
Answers Latest Update (2026/2027)
Guaranteed Pass
1. Menopause transition-changes in SHBG and testosterone? Ratio?
- ANS ✓SHBG decreases
Testosterone/SHBG ratio increases by 80%.
2. Testosterone/SHGB ratio is called what? - ANS ✓The free
androgen index
3. What stage are VMS more likely? - ANS ✓+1b (generally last 2
years)
4. What hormone is generally higher in obese women? - ANS
✓ Estrone-via aromatization.
5. The postmenopausal ovary continues to produce what two
hormones? - ANS ✓testosterone and androstenedione
6. Surgical menopause causes women to have lower levels of what
hormone? - ANS ✓testosterone. 40-50% lower than in women w/
intact ovaries.
NAMs Menopause Certification
, 2
NAMs
7. Driving piece of menopause is ovarian follicles depleting. What
does this do to the inhibin B and AMH? - ANS ✓inhibin and AMH
decrease
Therefore, follicle growth is not restrained, this allows for the growth of the
remaining, diminished follicle pool.
8. In the menopause transition, women spend more time in what
phase? - ANS ✓Luteal-more PMS symptoms, more frequent
menstrual periods.
9. HPO axis theory and the menopause transition - ANS ✓It is felt
that the HPO axis may become less sensitive to estrogen, so even with
good follicle growth and estradiol secretion, LH surges can fail which
can lead to more cycle irregularity.
10. In the first year after the FMP, there is no production of
what hormone? - ANS ✓progesterone
11. What region of the adrenal gland secretes the androgens? -
ANS ✓zona reticularis
12. What are considered the 'adrenal androgens'? - ANS
✓ DHEA, DHEAS, Androstenedione.
13. Aldosterone secretion from the zona reticularis in the
adrenal gland is regulated by 3 main factors. - ANS ✓Angiotensin
II, potassium concentration, adrenocorticotropic hormone secreted
by the anterior pituitary.
NAMs Menopause Certification
, 3
NAMs
14. What part of the pituitary gland secretes
adrenocorticotropic hormone? - ANS ✓Anterior pituitary. The
posterior only secretes vasopressin and oxytocin.
15. Cortisol and HRT - ANS ✓Most serum cortisol circulates
bound to cortisol binding globulin.
Oral estrogen increases the cortisol binding globulin, which increases total
cortisol concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum
cortisol concentration.
16. Do cortisol levels associate with VMS severity? - ANS ✓No,
cortisol levels have NOT been associated with more severe VMS.
17. Local DHEA has been proven to help with what? - ANS
✓ vaginal pain and dyspareunia
18. How to DX POI? - ANS ✓Menstrual disturbance-
oligomenorrhea or amenorrhea for at least 4 months.
AND
Elevated FSH over 25 on two occasions at least 4 weeks apart.
NAMs Menopause Certification
