NAMS Menopause Certification Exam
2026/2027 WITH OVER 200 QUESTIONS
AND CORRECT ANSWERS RATED
+[NEWEST!!!]
Climacteric phase
The period of endrocrinologic, somatic, and transitory psychologic changes that
occur around the time of menopause.
What is the FSH level on a random draw in Late menopause transition (STRAW
Stage: -1)?
25 IU/L 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
What happens to SHBG during menopause? How does that effect the free
androgen index?
SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
Testosterone:SHGB ratio is called what?
The free androgen index
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
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.
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.
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)
Vagina, vulva, urethra, trigone of the bladder
List the effects of estrogen on tissue (4+2)
1 ) maintains blood flow to tissue, maintains the collagen within the epithelium,
and maintains the hyaluronic acid and mucopolysaccharides within the moistened
epithelial surface, maintains pH (4.5) 2) supports microbiome and protects tissue
from pathogens
List the vaginal changes with menopause you might note on clinical/microscopic
exam.
Thinning of the epithelial layer, loss of elasticity with narrowing of the canal and
poor distention, noted on pelvic exam with loss or absence or rugae. Due to the
2026/2027 WITH OVER 200 QUESTIONS
AND CORRECT ANSWERS RATED
+[NEWEST!!!]
Climacteric phase
The period of endrocrinologic, somatic, and transitory psychologic changes that
occur around the time of menopause.
What is the FSH level on a random draw in Late menopause transition (STRAW
Stage: -1)?
25 IU/L 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
What happens to SHBG during menopause? How does that effect the free
androgen index?
SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
Testosterone:SHGB ratio is called what?
The free androgen index
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
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.
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.
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)
Vagina, vulva, urethra, trigone of the bladder
List the effects of estrogen on tissue (4+2)
1 ) maintains blood flow to tissue, maintains the collagen within the epithelium,
and maintains the hyaluronic acid and mucopolysaccharides within the moistened
epithelial surface, maintains pH (4.5) 2) supports microbiome and protects tissue
from pathogens
List the vaginal changes with menopause you might note on clinical/microscopic
exam.
Thinning of the epithelial layer, loss of elasticity with narrowing of the canal and
poor distention, noted on pelvic exam with loss or absence or rugae. Due to the
