NAMs Menopause Certification Exam Questions With Correct Answers 2026-2027
Marking Scheme New Update
1. The period of endrocrinologic, somatic, and transitory psychologic changes
that occur around the time of menopause.: Climacteric phase
2. LMP before age 45: Early menopause
3. LMP after age 54: Late menopause
4. Menopause that occurs before age 40: Primary ovarian insufficiency
5. Persistent difference of 7 days or more in the length of consecutive cycles.-
: Early menopause transition (stage -2)
6. 60 or more consecutive days of amenorrhea: Late menopause transition
(stage -1)
7. Explains why some perimenopausal women have elevated estrogen level
sometimes...In the early menopause transition, elevated FSH levels are ade-
quate 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.: Luteal out of phase event (LOOP)
8. 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): Obese women and estradiol levels
during menopause
9. These ethnic groups have lower estradiol levels then white, black and
hispanic women.: Chinese and Japanese women
10. late menopause stage: 5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.: stage +2
11. early post menopause: 2 years after FMP. FSH rises, estradiol decreases.
VMS predominate.: Stages +1a, +1b, +1c
12. Endocrine labs after menopause: Elevated FSH, LH
13. These hormones work during reproductive years to not deplete follicle
pool too quickly.: AMH, inhibin B
14. Menstrual cycle variable, persistent >7 day difference between difference
in length of consecutive cycles.: Phases during menopause transition and PMS
symptoms
15. many pitfalls, variable depending on the day of the cycle you draw the lab,
normal or low FSH is not helpful.: How to respond if a patient requests FSH lab?
16. AMH: The potentially superior marker of menopause, a lab.
17. Adrenal androgens: precursor hromones produced by the adrenal gland
that are enzymatically converted to active androgens or estrogens in periph-
eral tissues.: DHEA (dehydroepiandrosterone)
18. Vagina, vulva, urethra, trigone of the bladder: Location of estrogen receptors
,NAMs Menopause Certification Exam Questions With Correct Answers 2026-2027
Marking Scheme New Update
19. maintain blood flow, the collagen, and HA within the epithelial surfaces.
Supports microbiome which supports acidity of vagina and protects tissue
from pathogens.: Effects of estrogen on tissue
20. Thinning, loss of elasticity, loss or absence or rugae.: Vaginal changes with
menopause
21. vagina narrows, urethra moves closer to the introitus.: Vagina and urethra
in menopause
22. Vaginal estrogen and urinary incontinence: what type does it help with?: -
Stress urinary incontinence
23. Minoxidil, spironolactone, finasteride, estrogen therapy: Treatment for
FPHL
24. -3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low.
-3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low.-
: Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH,
AMH, AFC, inhibin?
25. Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal
FSH level.: When it is appropriate to check an FSH during the cycle if you check it?
and why?
26. 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.: AMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak?
27. 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.: AFC
,NAMs Menopause Certification Exam Questions With Correct Answers 2026-2027
Marking Scheme New Update
28. 25 or higher: Late menopause transition (-1) FSH level on random draw
29. Higher: Black women have higher or lower FSH levels?
30. lower: Chinese and Japanese women have higher or lower estradiol levels
compared to white, black and hispanic women?
31. SHBG decreases
Testosterone/SHBG ratio increases by 80%.: Menopause transition-changes in
SHBG and testosterone? ratio?
32. The free androgen index: Testosterone/SHGB ratio is called what?
33. +1b (generally last 2 years): What stage are VMS more likely?
34. Estrone-via aromatization.: What hormone is generally higher in obese
women?
35. testosterone and androstenedione: The postmenopausal ovary continues to
produce what two hormones?
36. testosterone. 40-50% lower than in women w/ intact ovaries.: Surgical
menopause causes women to have lower levels of what hormone?
37. inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the re-
maining, diminished follicle pool.: Driving piece of menopause is ovarian follicles
depleting. What does this do to the inhibin B and AMH?
38. Luteal-more PMS symptoms, more frequent menstrual periods.: In the
menopause transition, women spend more time in what phase?
39. 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.: HPO axis theory and the menopause transition
40. progesterone: In the first year after the FMP, there is no production of what
hormone?
41. zona reticularis: What region of the adrenal gland secretes the androgens?
42. DHEA, DHEAS, Androstenedione.: what are considered the 'adrenal andro-
gens'?
43. Angiotensin II, potassium concentration, adrenocorticotropic hormone se-
creted by the anterior pituitary.: Aldosterone secretion from the zona reticularis in
the adrenal gland is regulated by 3 main factors.
44. Anterior pituitary. The posterior only secretes vasopressin and oxytosin.-
: What part of the pituitary gland secretes adrenocorticotropic hormone?
45. Most serum cortisol circulates bound to cortisol binding globulin.
Oral estrogen increases the cortisol binding globulin, which increases total
,NAMs Menopause Certification Exam Questions With Correct Answers 2026-2027
Marking Scheme New Update
cortisol concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol
concentration.: Cortisol and HRT
46. No, cortisol levels have NOT been associated with more severe VMS.: Do
cortisol levels associate with VMS severity?
47. vaginal pain and dyspareunia: Local DHEA has been proven to help with
what?
48. Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4
months.
AND
elevated FSH over 25 on two occasions at least 4 weeks apart.: How to DX POI?
49. prolactin
FSH
estradiol
TSH
pregnancy test: Anyone <40years old who misses 3+ consecutive cycles gets
these labs
50. 100 microgram estradiol patch
1.25 mg CEE
2mg oral estradiol
If intact uterus-progesterone for 12 days of the month.
Physiologic is better than continuous hormonal contractption, but if menor-
rhagia-IUD plus estrogen patch, or if really not wanting to risk pregnancy,
continuous HRT can be used.: treatment of POI
51. FPHL is gradual, telogen effluvium is sudden and usually precipitated by
a life stressor, chronic illness, beta blockers or anticoagulants-usually more
patchy hair loss.: Hair loss. Difference between FPHL and telogen effluvium?
52. thinning at the crown of the head and widening of the hair part: FPHL
pattern
Marking Scheme New Update
1. The period of endrocrinologic, somatic, and transitory psychologic changes
that occur around the time of menopause.: Climacteric phase
2. LMP before age 45: Early menopause
3. LMP after age 54: Late menopause
4. Menopause that occurs before age 40: Primary ovarian insufficiency
5. Persistent difference of 7 days or more in the length of consecutive cycles.-
: Early menopause transition (stage -2)
6. 60 or more consecutive days of amenorrhea: Late menopause transition
(stage -1)
7. Explains why some perimenopausal women have elevated estrogen level
sometimes...In the early menopause transition, elevated FSH levels are ade-
quate 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.: Luteal out of phase event (LOOP)
8. 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): Obese women and estradiol levels
during menopause
9. These ethnic groups have lower estradiol levels then white, black and
hispanic women.: Chinese and Japanese women
10. late menopause stage: 5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.: stage +2
11. early post menopause: 2 years after FMP. FSH rises, estradiol decreases.
VMS predominate.: Stages +1a, +1b, +1c
12. Endocrine labs after menopause: Elevated FSH, LH
13. These hormones work during reproductive years to not deplete follicle
pool too quickly.: AMH, inhibin B
14. Menstrual cycle variable, persistent >7 day difference between difference
in length of consecutive cycles.: Phases during menopause transition and PMS
symptoms
15. many pitfalls, variable depending on the day of the cycle you draw the lab,
normal or low FSH is not helpful.: How to respond if a patient requests FSH lab?
16. AMH: The potentially superior marker of menopause, a lab.
17. Adrenal androgens: precursor hromones produced by the adrenal gland
that are enzymatically converted to active androgens or estrogens in periph-
eral tissues.: DHEA (dehydroepiandrosterone)
18. Vagina, vulva, urethra, trigone of the bladder: Location of estrogen receptors
,NAMs Menopause Certification Exam Questions With Correct Answers 2026-2027
Marking Scheme New Update
19. maintain blood flow, the collagen, and HA within the epithelial surfaces.
Supports microbiome which supports acidity of vagina and protects tissue
from pathogens.: Effects of estrogen on tissue
20. Thinning, loss of elasticity, loss or absence or rugae.: Vaginal changes with
menopause
21. vagina narrows, urethra moves closer to the introitus.: Vagina and urethra
in menopause
22. Vaginal estrogen and urinary incontinence: what type does it help with?: -
Stress urinary incontinence
23. Minoxidil, spironolactone, finasteride, estrogen therapy: Treatment for
FPHL
24. -3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low.
-3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low.-
: Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH,
AMH, AFC, inhibin?
25. Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal
FSH level.: When it is appropriate to check an FSH during the cycle if you check it?
and why?
26. 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.: AMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak?
27. 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.: AFC
,NAMs Menopause Certification Exam Questions With Correct Answers 2026-2027
Marking Scheme New Update
28. 25 or higher: Late menopause transition (-1) FSH level on random draw
29. Higher: Black women have higher or lower FSH levels?
30. lower: Chinese and Japanese women have higher or lower estradiol levels
compared to white, black and hispanic women?
31. SHBG decreases
Testosterone/SHBG ratio increases by 80%.: Menopause transition-changes in
SHBG and testosterone? ratio?
32. The free androgen index: Testosterone/SHGB ratio is called what?
33. +1b (generally last 2 years): What stage are VMS more likely?
34. Estrone-via aromatization.: What hormone is generally higher in obese
women?
35. testosterone and androstenedione: The postmenopausal ovary continues to
produce what two hormones?
36. testosterone. 40-50% lower than in women w/ intact ovaries.: Surgical
menopause causes women to have lower levels of what hormone?
37. inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the re-
maining, diminished follicle pool.: Driving piece of menopause is ovarian follicles
depleting. What does this do to the inhibin B and AMH?
38. Luteal-more PMS symptoms, more frequent menstrual periods.: In the
menopause transition, women spend more time in what phase?
39. 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.: HPO axis theory and the menopause transition
40. progesterone: In the first year after the FMP, there is no production of what
hormone?
41. zona reticularis: What region of the adrenal gland secretes the androgens?
42. DHEA, DHEAS, Androstenedione.: what are considered the 'adrenal andro-
gens'?
43. Angiotensin II, potassium concentration, adrenocorticotropic hormone se-
creted by the anterior pituitary.: Aldosterone secretion from the zona reticularis in
the adrenal gland is regulated by 3 main factors.
44. Anterior pituitary. The posterior only secretes vasopressin and oxytosin.-
: What part of the pituitary gland secretes adrenocorticotropic hormone?
45. Most serum cortisol circulates bound to cortisol binding globulin.
Oral estrogen increases the cortisol binding globulin, which increases total
,NAMs Menopause Certification Exam Questions With Correct Answers 2026-2027
Marking Scheme New Update
cortisol concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol
concentration.: Cortisol and HRT
46. No, cortisol levels have NOT been associated with more severe VMS.: Do
cortisol levels associate with VMS severity?
47. vaginal pain and dyspareunia: Local DHEA has been proven to help with
what?
48. Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4
months.
AND
elevated FSH over 25 on two occasions at least 4 weeks apart.: How to DX POI?
49. prolactin
FSH
estradiol
TSH
pregnancy test: Anyone <40years old who misses 3+ consecutive cycles gets
these labs
50. 100 microgram estradiol patch
1.25 mg CEE
2mg oral estradiol
If intact uterus-progesterone for 12 days of the month.
Physiologic is better than continuous hormonal contractption, but if menor-
rhagia-IUD plus estrogen patch, or if really not wanting to risk pregnancy,
continuous HRT can be used.: treatment of POI
51. FPHL is gradual, telogen effluvium is sudden and usually precipitated by
a life stressor, chronic illness, beta blockers or anticoagulants-usually more
patchy hair loss.: Hair loss. Difference between FPHL and telogen effluvium?
52. thinning at the crown of the head and widening of the hair part: FPHL
pattern
