NAMS MENOPAUSE
CERTIFICATION EXAM
QUESTIONS AND ANSWERS
GRADED A+
Location of estrogen receptors - ANSWERS>>>>>Vagina,
vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - ANSWERS>>>>>maintain
blood flow, the collagen, and HA within the epithelial
surfaces. Supports microbiome which supports acidity of
vagina and protects tissue from pathogens.
Vaginal changes with menopause - ANSWERS>>>>>Thinning,
loss of elasticity, loss or absence or rugae.
Vagina and urethra in menopause - ANSWERS>>>>>vagina
narrows, urethra moves closer to the introitus.
Stress urinary incontinence - ANSWERS>>>>>Vaginal
estrogen and urinary incontinence: what type does it
help with?
Treatment for FPHL - ANSWERS>>>>>Minoxidil,
spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with
menstrual cycles, FSH, AMH, AFC, inhibin? -
ANSWERS>>>>>-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? - ANSWERS>>>>>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?
When does it peak? - ANSWERS>>>>>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.
Climacteric phase - ANSWERS>>>>>The period of
endrocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
Early menopause - ANSWERS>>>>>LMP before age 45
Late menopause - ANSWERS>>>>>LMP after age 54
,Primary ovarian insufficiency - ANSWERS>>>>>Menopause
that occurs before age 40
Early menopause transition (stage -2) -
ANSWERS>>>>>Persistent difference of 7 days or more in
the length of consecutive cycles.
Late menopause transition (stage -1) - ANSWERS>>>>>60
or more consecutive days of amenorrhea
Luteal out of phase event (LOOP) - ANSWERS>>>>>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 -
ANSWERS>>>>>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 - ANSWERS>>>>>These ethnic
groups have lower estradiol levels then white, black
and hispanic women.
stage +2 - ANSWERS>>>>>late menopause stage: 5-8 years
after FMP. Somatic aging predominates. Increased
genitourinary symptoms.
Stages +1a, +1b, +1c - ANSWERS>>>>>early post
menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
, Elevated FSH, LH - ANSWERS>>>>>Endocrine labs after
menopause
AMH, inhibin B - ANSWERS>>>>>These hormones work during
reproductive years to not deplete follicle pool too
quickly.
Phases during menopause transition and PMS symptoms -
ANSWERS>>>>>Menstrual cycle variable, persistent >7 day
difference between difference in length of consecutive
cycles.
How to respond if a patient requests FSH lab? -
ANSWERS>>>>>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. -
ANSWERS>>>>>AMH
DHEA (dehydroepiandrosterone) - ANSWERS>>>>>Adrenal
androgens: precursor hromones produced by the adrenal
gland that are enzymatically converted to active
androgens or estrogens in peripheral tissues.
AFC - ANSWERS>>>>>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.
Late menopause transition (-1) FSH level on random draw
- ANSWERS>>>>>25 or higher
CERTIFICATION EXAM
QUESTIONS AND ANSWERS
GRADED A+
Location of estrogen receptors - ANSWERS>>>>>Vagina,
vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - ANSWERS>>>>>maintain
blood flow, the collagen, and HA within the epithelial
surfaces. Supports microbiome which supports acidity of
vagina and protects tissue from pathogens.
Vaginal changes with menopause - ANSWERS>>>>>Thinning,
loss of elasticity, loss or absence or rugae.
Vagina and urethra in menopause - ANSWERS>>>>>vagina
narrows, urethra moves closer to the introitus.
Stress urinary incontinence - ANSWERS>>>>>Vaginal
estrogen and urinary incontinence: what type does it
help with?
Treatment for FPHL - ANSWERS>>>>>Minoxidil,
spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with
menstrual cycles, FSH, AMH, AFC, inhibin? -
ANSWERS>>>>>-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? - ANSWERS>>>>>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?
When does it peak? - ANSWERS>>>>>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.
Climacteric phase - ANSWERS>>>>>The period of
endrocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
Early menopause - ANSWERS>>>>>LMP before age 45
Late menopause - ANSWERS>>>>>LMP after age 54
,Primary ovarian insufficiency - ANSWERS>>>>>Menopause
that occurs before age 40
Early menopause transition (stage -2) -
ANSWERS>>>>>Persistent difference of 7 days or more in
the length of consecutive cycles.
Late menopause transition (stage -1) - ANSWERS>>>>>60
or more consecutive days of amenorrhea
Luteal out of phase event (LOOP) - ANSWERS>>>>>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 -
ANSWERS>>>>>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 - ANSWERS>>>>>These ethnic
groups have lower estradiol levels then white, black
and hispanic women.
stage +2 - ANSWERS>>>>>late menopause stage: 5-8 years
after FMP. Somatic aging predominates. Increased
genitourinary symptoms.
Stages +1a, +1b, +1c - ANSWERS>>>>>early post
menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
, Elevated FSH, LH - ANSWERS>>>>>Endocrine labs after
menopause
AMH, inhibin B - ANSWERS>>>>>These hormones work during
reproductive years to not deplete follicle pool too
quickly.
Phases during menopause transition and PMS symptoms -
ANSWERS>>>>>Menstrual cycle variable, persistent >7 day
difference between difference in length of consecutive
cycles.
How to respond if a patient requests FSH lab? -
ANSWERS>>>>>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. -
ANSWERS>>>>>AMH
DHEA (dehydroepiandrosterone) - ANSWERS>>>>>Adrenal
androgens: precursor hromones produced by the adrenal
gland that are enzymatically converted to active
androgens or estrogens in peripheral tissues.
AFC - ANSWERS>>>>>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.
Late menopause transition (-1) FSH level on random draw
- ANSWERS>>>>>25 or higher
