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NAMS Menopause Certification Exam
2025/ 2026, Menopause
Climacteric phase
The period of endrocrinologic, somatic, and transitory psychologic changes that
occur around the time of menopause.
Perimenopause Menopause Transition, Early
List the STRAW Stage
What defines the phase?
STRAW Stage: (Stage -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
Perimenopause Menopause Transition, Late
List the STRAW Stage
What defines the phase?
STRAW Stage: (Stage -1)
60 or more consecutive days of amenorrhea
pg. 1
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Luteal out of phase event (LOOP)
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.
Describe the E2 level during the life of a patient with obesity.
They are also more likely to have lower premenopause/perimenopausal estradiol
levels compared to patients with average BMIs. However, the level is the highest
in postmenopausal patients with obesity.
In comparison to other ethnicities, Chinese and Japanese women have ___ E2
levels?
These ethnic groups have lower estradiol levels than white, black and hispanic
women.
STRAW Stage +2, describe the timeline as well as the predominant symptoms.
pg. 2
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Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c, describe the timeline as well as the supportive criteria and
the symptoms.
Postmenopause, Early. 2 years after FMP.
+1a/b (2yrs) FSH variable where as the AMH and InhB are low. The AFC are very
low. VMS predominate.
1c (3-6yrs) FSH levels stabilize. The other measures continue as previous.
Elevated FSH, LH
Endocrine labs after menopause
AMH, Inhibin B
These hormones work during reproductive years to not deplete follicle pool too
quickly.
pg. 3
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Describe the phases during the early menopause transition and what happens
with PMS symptoms
Menstrual cycle shortens. Due to unrestrained FSH, follicular phase compresses.
More premenstrual symptoms due to the longer luteal phase. Cycle irregularity
and skipped cycles because of ovulatory failure and increased atresia.
How to respond if a patient requests FSH lab?
many pitfalls, variable depending on the day of the cycle you draw the lab, normal
or low FSH is not helpful.
What lab is potentially the superior marker of time to menopause?
AMH
DHEA (dehydroepiandrosterone)
Adrenal androgens: precursor hromones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in peripheral tissues.
Location of GU estrogen receptors (4)
pg. 4
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UPDATE Page 1 of 74 COMPLETE SOLUTIONS
NAMS Menopause Certification Exam
2025/ 2026, Menopause
Climacteric phase
The period of endrocrinologic, somatic, and transitory psychologic changes that
occur around the time of menopause.
Perimenopause Menopause Transition, Early
List the STRAW Stage
What defines the phase?
STRAW Stage: (Stage -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
Perimenopause Menopause Transition, Late
List the STRAW Stage
What defines the phase?
STRAW Stage: (Stage -1)
60 or more consecutive days of amenorrhea
pg. 1
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UPDATE Page 2 of 74 COMPLETE SOLUTIONS
Luteal out of phase event (LOOP)
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.
Describe the E2 level during the life of a patient with obesity.
They are also more likely to have lower premenopause/perimenopausal estradiol
levels compared to patients with average BMIs. However, the level is the highest
in postmenopausal patients with obesity.
In comparison to other ethnicities, Chinese and Japanese women have ___ E2
levels?
These ethnic groups have lower estradiol levels than white, black and hispanic
women.
STRAW Stage +2, describe the timeline as well as the predominant symptoms.
pg. 2
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UPDATE Page 3 of 74 COMPLETE SOLUTIONS
Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c, describe the timeline as well as the supportive criteria and
the symptoms.
Postmenopause, Early. 2 years after FMP.
+1a/b (2yrs) FSH variable where as the AMH and InhB are low. The AFC are very
low. VMS predominate.
1c (3-6yrs) FSH levels stabilize. The other measures continue as previous.
Elevated FSH, LH
Endocrine labs after menopause
AMH, Inhibin B
These hormones work during reproductive years to not deplete follicle pool too
quickly.
pg. 3
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UPDATE Page 4 of 74 COMPLETE SOLUTIONS
Describe the phases during the early menopause transition and what happens
with PMS symptoms
Menstrual cycle shortens. Due to unrestrained FSH, follicular phase compresses.
More premenstrual symptoms due to the longer luteal phase. Cycle irregularity
and skipped cycles because of ovulatory failure and increased atresia.
How to respond if a patient requests FSH lab?
many pitfalls, variable depending on the day of the cycle you draw the lab, normal
or low FSH is not helpful.
What lab is potentially the superior marker of time to menopause?
AMH
DHEA (dehydroepiandrosterone)
Adrenal androgens: precursor hromones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in peripheral tissues.
Location of GU estrogen receptors (4)
pg. 4
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