NAMS MENOPAUSE CERTIFICATION
EXAM 2026/2027 WITH OVER 300
QUESTIONS AND CORRECT
ANSWERS RATED +[NEWEST!!!]
What region of the adrenal gland secretes the androgens?
Zona reticularis.
Climacteric phase
The period of endocrinologic, somatic, and transitory psychologic changes that
occur around the time of menopause.
Early menopause
LMP before age 45.
Late menopause
LMP after age 54.
Primary ovarian insufficiency
Menopause that occurs before age 40.
Early menopause transition (stage -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1)
60 or more consecutive days of amenorrhea.
Luteal out of phase event (LOOP)
Explains why some perimenopausal women have elevated estrogen levels
sometimes.
Obese women and estradiol levels during menopause
Obese women are more likely to have anovulatory cycles with high estradiol
levels.
,Chinese and Japanese women
These ethnic groups have lower estradiol levels than white, black, and Hispanic
women.
Stage +2
Late menopause stage: 5-8 years after FMP. Somatic aging predominates.
Stages +1a, +1b, +1c
Early post menopause: 2 years after FMP. FSH rises, estradiol decreases.
Elevated FSH, LH
Endocrine labs after menopause.
AMH, inhibin B
These hormones work during reproductive years to not deplete follicle pool too
quickly.
Phases during menopause transition and PMS symptoms
Menstrual cycle variable, persistent >7 day difference between difference in length
of consecutive cycles.
How to respond if a patient requests FSH lab?
Many pitfalls, variable depending on the day of the cycle you draw the lab.
The potentially superior marker of menopause, a lab.
AMH.
DHEA (dehydroepiandrosterone)
Adrenal androgens: precursor hormones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in peripheral tissues.
Location of estrogen receptors
Vagina, vulva, urethra, trigone of the bladder.
Higher.
Chinese and Japanese women have higher or lower estradiol levels compared to
white, black and Hispanic women?
,Lower.
Menopause transition-changes in SHBG and testosterone?
SHBG decreases. Testosterone/SHBG ratio increases by 80%.
Testosterone/SHBG ratio is called what?
The free androgen index.
What stage are VMS more likely?
+1b (generally last 2 years).
What hormone is generally higher in obese women?
Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones?
Testosterone and androstenedione.
Surgical menopause causes women to have lower levels of what hormone?
Testosterone. 40-50% lower than in women w/ intact ovaries.
Driving piece of menopause is ovarian follicles depleting. What does this do to the
inhibin B and AMH?
Inhibin and AMH decrease.
In the menopause transition, women spend more time in what phase?
Luteal-more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition
It is felt that the HPO axis may become less sensitive to estrogen.
In the first year after the FMP, there is no production of what hormone?
Progesterone.
What are considered the 'adrenal androgens'?
DHEA, DHEAS, Androstenedione.
, Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by
3 main factors.
Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by
the anterior pituitary.
What part of the pituitary gland secretes adrenocorticotropic hormone?
Anterior pituitary.
Cortisol and HRT
Most serum cortisol circulates bound to cortisol binding globulin.
Do cortisol levels associate with VMS severity?
No, cortisol levels have NOT been associated with more severe VMS.
Local DHEA has been proven to help with what?
Vaginal pain and dyspareunia.
How to DX POI?
Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months and
elevated FSH over 25 on two occasions at least 4 weeks apart.
Anyone <40 years old who misses 3+ consecutive cycles gets these labs
Prolactin, FSH, estradiol, TSH, pregnancy test.
Treatment of POI
100 microgram estradiol patch, 1.25 mg CEE, 2mg oral estradiol.
Physiologic
Better than continuous hormonal contraception.
Effects of estrogen on tissue
Maintain blood flow, the collagen, and HA within the epithelial surfaces.
Vaginal changes with menopause
Thinning, loss of elasticity, loss or absence of rugae.
EXAM 2026/2027 WITH OVER 300
QUESTIONS AND CORRECT
ANSWERS RATED +[NEWEST!!!]
What region of the adrenal gland secretes the androgens?
Zona reticularis.
Climacteric phase
The period of endocrinologic, somatic, and transitory psychologic changes that
occur around the time of menopause.
Early menopause
LMP before age 45.
Late menopause
LMP after age 54.
Primary ovarian insufficiency
Menopause that occurs before age 40.
Early menopause transition (stage -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1)
60 or more consecutive days of amenorrhea.
Luteal out of phase event (LOOP)
Explains why some perimenopausal women have elevated estrogen levels
sometimes.
Obese women and estradiol levels during menopause
Obese women are more likely to have anovulatory cycles with high estradiol
levels.
,Chinese and Japanese women
These ethnic groups have lower estradiol levels than white, black, and Hispanic
women.
Stage +2
Late menopause stage: 5-8 years after FMP. Somatic aging predominates.
Stages +1a, +1b, +1c
Early post menopause: 2 years after FMP. FSH rises, estradiol decreases.
Elevated FSH, LH
Endocrine labs after menopause.
AMH, inhibin B
These hormones work during reproductive years to not deplete follicle pool too
quickly.
Phases during menopause transition and PMS symptoms
Menstrual cycle variable, persistent >7 day difference between difference in length
of consecutive cycles.
How to respond if a patient requests FSH lab?
Many pitfalls, variable depending on the day of the cycle you draw the lab.
The potentially superior marker of menopause, a lab.
AMH.
DHEA (dehydroepiandrosterone)
Adrenal androgens: precursor hormones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in peripheral tissues.
Location of estrogen receptors
Vagina, vulva, urethra, trigone of the bladder.
Higher.
Chinese and Japanese women have higher or lower estradiol levels compared to
white, black and Hispanic women?
,Lower.
Menopause transition-changes in SHBG and testosterone?
SHBG decreases. Testosterone/SHBG ratio increases by 80%.
Testosterone/SHBG ratio is called what?
The free androgen index.
What stage are VMS more likely?
+1b (generally last 2 years).
What hormone is generally higher in obese women?
Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones?
Testosterone and androstenedione.
Surgical menopause causes women to have lower levels of what hormone?
Testosterone. 40-50% lower than in women w/ intact ovaries.
Driving piece of menopause is ovarian follicles depleting. What does this do to the
inhibin B and AMH?
Inhibin and AMH decrease.
In the menopause transition, women spend more time in what phase?
Luteal-more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition
It is felt that the HPO axis may become less sensitive to estrogen.
In the first year after the FMP, there is no production of what hormone?
Progesterone.
What are considered the 'adrenal androgens'?
DHEA, DHEAS, Androstenedione.
, Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by
3 main factors.
Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by
the anterior pituitary.
What part of the pituitary gland secretes adrenocorticotropic hormone?
Anterior pituitary.
Cortisol and HRT
Most serum cortisol circulates bound to cortisol binding globulin.
Do cortisol levels associate with VMS severity?
No, cortisol levels have NOT been associated with more severe VMS.
Local DHEA has been proven to help with what?
Vaginal pain and dyspareunia.
How to DX POI?
Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months and
elevated FSH over 25 on two occasions at least 4 weeks apart.
Anyone <40 years old who misses 3+ consecutive cycles gets these labs
Prolactin, FSH, estradiol, TSH, pregnancy test.
Treatment of POI
100 microgram estradiol patch, 1.25 mg CEE, 2mg oral estradiol.
Physiologic
Better than continuous hormonal contraception.
Effects of estrogen on tissue
Maintain blood flow, the collagen, and HA within the epithelial surfaces.
Vaginal changes with menopause
Thinning, loss of elasticity, loss or absence of rugae.
