NAMS CERTIFICATION LATEST 2026 TEST PAPER
QUESTIONS AND ANSWERS GRADED A+
✔✔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 estrogen receptors - ✔✔Vagina, vulva, urethra, trigone of the bladder
✔✔Effects of estrogen on tissue - ✔✔maintain blood flow, the collagen, and HA within
the epithelial surfaces. Supports microbiome and protects tissue from pathogens.
✔✔Vaginal changes with menopause - ✔✔Thinning, loss of elasticity, loss or absence
or rugae.
✔✔Vagina and urethra in menopause - ✔✔vagina narrows, urethra moves closer to the
introitus.
✔✔Stress urinary incontinence - ✔✔Vaginal estrogen and urinary incontinence: what
type does it help with?
✔✔Treatment for FPHL - ✔✔Minoxidil, spironolactone, finasteride, estrogen therapy
✔✔Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH,
AMH, AFC, inhibin? - ✔✔-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? -
✔✔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? - ✔✔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 - ✔✔Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability poo of follicles.
✔✔Late menopause transition (-1) FSH level on random draw - ✔✔25 or higher
✔✔Black women have higher or lower FSH levels? - ✔✔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? ratio? - ✔✔SHBG
decreases
Testosterone/SHBG ratio increases by 80%.
✔✔Testosterone/SHGB 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
therefore, follicle growth is not restrained, this allows for the growth of the remaining,
diminished follicle pool.
✔✔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, so even with good follicle growth and estradiol
secretion, LH surges can fail which can lead to more cycle irregularity.
QUESTIONS AND ANSWERS GRADED A+
✔✔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 estrogen receptors - ✔✔Vagina, vulva, urethra, trigone of the bladder
✔✔Effects of estrogen on tissue - ✔✔maintain blood flow, the collagen, and HA within
the epithelial surfaces. Supports microbiome and protects tissue from pathogens.
✔✔Vaginal changes with menopause - ✔✔Thinning, loss of elasticity, loss or absence
or rugae.
✔✔Vagina and urethra in menopause - ✔✔vagina narrows, urethra moves closer to the
introitus.
✔✔Stress urinary incontinence - ✔✔Vaginal estrogen and urinary incontinence: what
type does it help with?
✔✔Treatment for FPHL - ✔✔Minoxidil, spironolactone, finasteride, estrogen therapy
✔✔Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH,
AMH, AFC, inhibin? - ✔✔-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? -
✔✔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? - ✔✔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 - ✔✔Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability poo of follicles.
✔✔Late menopause transition (-1) FSH level on random draw - ✔✔25 or higher
✔✔Black women have higher or lower FSH levels? - ✔✔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? ratio? - ✔✔SHBG
decreases
Testosterone/SHBG ratio increases by 80%.
✔✔Testosterone/SHGB 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
therefore, follicle growth is not restrained, this allows for the growth of the remaining,
diminished follicle pool.
✔✔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, so even with good follicle growth and estradiol
secretion, LH surges can fail which can lead to more cycle irregularity.
