Nams Menopause Certification Final Exam 2025 With
Questions And Answers
Climacteric phase - correct answers The period of endrocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause - correct answers LMP before age 45
Late menopause - correct answers LMP after age 54
Primary ovarian insufficiency - correct answers Menopause that occurs before age 40
Early menopause transition (stage -2) - correct answers Persistent difference of 7 days or more
in the length of consecutive cycles.
Late menopause transition (stage -1) - correct answers 60 or more consecutive days of
amenorrhea
Luteal out of phase event (LOOP) - correct 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 - correct 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 - correct answers These ethnic groups have lower estradiol levels
then white, black and hispanic women.
stage +2 - correct answers late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - correct answers early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
Elevated FSH, LH - correct answers Endocrine labs after menopause
AMH, inhibin B - correct answers These hormones work during reproductive years to not
deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms - correct answers Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? - correct 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. - correct answers AMH
DHEA (dehydroepiandrosterone) - correct answers 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 answers Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - correct 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 - correct answers Thinning, loss of elasticity, loss or absence
or rugae.
Vagina and urethra in menopause - correct answers vagina narrows, urethra moves closer to
the introitus.
Stress urinary incontinence - correct answers Vaginal estrogen and urinary incontinence: what
type does it help with?
Treatment for FPHL - correct answers Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC,
inhibin? - correct 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? - correct
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? - correct 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.
AFC - correct 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 - correct answers 25 or higher
Black women have higher or lower FSH levels? - correct answers Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and hispanic women? - correct answers lower
Menopause transition-changes in SHBG and testosterone? ratio? - correct answers SHBG
decreases
Questions And Answers
Climacteric phase - correct answers The period of endrocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause - correct answers LMP before age 45
Late menopause - correct answers LMP after age 54
Primary ovarian insufficiency - correct answers Menopause that occurs before age 40
Early menopause transition (stage -2) - correct answers Persistent difference of 7 days or more
in the length of consecutive cycles.
Late menopause transition (stage -1) - correct answers 60 or more consecutive days of
amenorrhea
Luteal out of phase event (LOOP) - correct 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 - correct 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 - correct answers These ethnic groups have lower estradiol levels
then white, black and hispanic women.
stage +2 - correct answers late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - correct answers early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
Elevated FSH, LH - correct answers Endocrine labs after menopause
AMH, inhibin B - correct answers These hormones work during reproductive years to not
deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms - correct answers Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? - correct 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. - correct answers AMH
DHEA (dehydroepiandrosterone) - correct answers 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 answers Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - correct 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 - correct answers Thinning, loss of elasticity, loss or absence
or rugae.
Vagina and urethra in menopause - correct answers vagina narrows, urethra moves closer to
the introitus.
Stress urinary incontinence - correct answers Vaginal estrogen and urinary incontinence: what
type does it help with?
Treatment for FPHL - correct answers Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC,
inhibin? - correct 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? - correct
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? - correct 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.
AFC - correct 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 - correct answers 25 or higher
Black women have higher or lower FSH levels? - correct answers Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and hispanic women? - correct answers lower
Menopause transition-changes in SHBG and testosterone? ratio? - correct answers SHBG
decreases
