1|Page
CCMA Certification study guide 2025
Climacteric phase - .....ANSWER ...✔✔ The period of
endrocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
Early menopause - .....ANSWER ...✔✔ LMP before
age 45
Late menopause - .....ANSWER ...✔✔ LMP after age
54
Primary ovarian insufficiency - .....ANSWER ...✔✔
Menopause that occurs before age 40
Early menopause transition (stage -2) - .....ANSWER
...✔✔ Persistent difference of 7 days or more in the
length of consecutive cycles.
Late menopause transition (stage -1) - .....ANSWER
...✔✔ 60 or more consecutive days of amenorrhea
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Luteal out of phase event (LOOP) - .....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 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 -
.....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 - .....ANSWER ...✔✔
These ethnic groups have lower estradiol levels then
white, black and hispanic women.
stage +2 - .....ANSWER ...✔✔ late menopause stage:
5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.
,3|Page
Stages +1a, +1b, +1c - .....ANSWER ...✔✔ early
post menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
Elevated FSH, LH - .....ANSWER ...✔✔ Endocrine labs
after menopause
AMH, inhibin B - .....ANSWER ...✔✔ These hormones
work during reproductive years to not deplete follicle
pool too quickly.
Phases during menopause transition and PMS symptoms
- .....ANSWER ...✔✔ Menstrual cycle variable,
persistent >7 day difference between difference in
length of consecutive cycles.
How to respond if a patient requests FSH lab? -
.....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. -
.....ANSWER ...✔✔ AMH
, 4|Page
DHEA (dehydroepiandrosterone) - .....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 - .....ANSWER ...✔✔
Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - .....ANSWER ...✔✔
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 - .....ANSWER
...✔✔ Thinning, loss of elasticity, loss or absence or
rugae.
Vagina and urethra in menopause - .....ANSWER
...✔✔ vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence - .....ANSWER ...✔✔
Vaginal estrogen and urinary incontinence: what type
does it help with?
CCMA Certification study guide 2025
Climacteric phase - .....ANSWER ...✔✔ The period of
endrocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
Early menopause - .....ANSWER ...✔✔ LMP before
age 45
Late menopause - .....ANSWER ...✔✔ LMP after age
54
Primary ovarian insufficiency - .....ANSWER ...✔✔
Menopause that occurs before age 40
Early menopause transition (stage -2) - .....ANSWER
...✔✔ Persistent difference of 7 days or more in the
length of consecutive cycles.
Late menopause transition (stage -1) - .....ANSWER
...✔✔ 60 or more consecutive days of amenorrhea
,2|Page
Luteal out of phase event (LOOP) - .....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 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 -
.....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 - .....ANSWER ...✔✔
These ethnic groups have lower estradiol levels then
white, black and hispanic women.
stage +2 - .....ANSWER ...✔✔ late menopause stage:
5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.
,3|Page
Stages +1a, +1b, +1c - .....ANSWER ...✔✔ early
post menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
Elevated FSH, LH - .....ANSWER ...✔✔ Endocrine labs
after menopause
AMH, inhibin B - .....ANSWER ...✔✔ These hormones
work during reproductive years to not deplete follicle
pool too quickly.
Phases during menopause transition and PMS symptoms
- .....ANSWER ...✔✔ Menstrual cycle variable,
persistent >7 day difference between difference in
length of consecutive cycles.
How to respond if a patient requests FSH lab? -
.....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. -
.....ANSWER ...✔✔ AMH
, 4|Page
DHEA (dehydroepiandrosterone) - .....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 - .....ANSWER ...✔✔
Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - .....ANSWER ...✔✔
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 - .....ANSWER
...✔✔ Thinning, loss of elasticity, loss or absence or
rugae.
Vagina and urethra in menopause - .....ANSWER
...✔✔ vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence - .....ANSWER ...✔✔
Vaginal estrogen and urinary incontinence: what type
does it help with?
