NAMS MENOPAUSE COMPREHENSIVE QUESTIONS
AND ANSWERS SURE A+
✔✔Stress urinary incontinence - ✔✔Vaginal estrogen and urinary incontinence: what
type does it help with?
✔✔Treatment for FPHL - ✔✔Minoxidil, spironolactone, finasteride, estrogen therapy.
✔✔Late reproductive years -3b and -3a - ✔✔-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? - ✔✔Cycle
day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
✔✔AFC - ✔✔Antral follicle count. Number of follicles that are detectable with
ultrasound.
✔✔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? - ✔✔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 region of the adrenal gland secretes the androgens? - ✔✔Zona reticularis.
✔✔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.
✔✔Menorrhagia treatment - ✔✔IUD plus estrogen patch or continuous HRT.
✔✔FPHL vs Telogen Effluvium - ✔✔FPHL is gradual, telogen effluvium is sudden and
usually precipitated by a life stressor.
✔✔FPHL pattern - ✔✔Thinning at the crown of the head and widening of the hair part.
✔✔Treating FPHL - ✔✔Minoxidil, spironolactone, finasteride.
✔✔Ethnicity least likely to have bad hot flashes - ✔✔Japanese.
✔✔Ethnicity most likely to have bad hot flashes - ✔✔Black, more frequent, longer
duration.
✔✔Median length of hot flashes - ✔✔10 years.
✔✔Theories about etiology of hot flashes - ✔✔Lower ovarian estradiol thermoregulation
zone is narrowed, neurokinins regulate GnRH secretion.
✔✔VIN low grade - ✔✔Not precancerous.
✔✔VIN high grade - ✔✔Precancerous; requires GYN ONC intervention.
✔✔Most common type of vulvar cancer - ✔✔Squamous cell carcinoma.
✔✔Vulvar disorder misdiagnosed as eczema - ✔✔Paget's disease.
✔✔Normal PVR - ✔✔<100mL.
✔✔Estrogen and urinary incontinence - ✔✔Will NOT help with stress incontinence.
✔✔Topical vaginal estrogen with highest dose - ✔✔Vaginal rings; FEMRING is the
highest.
AND ANSWERS SURE A+
✔✔Stress urinary incontinence - ✔✔Vaginal estrogen and urinary incontinence: what
type does it help with?
✔✔Treatment for FPHL - ✔✔Minoxidil, spironolactone, finasteride, estrogen therapy.
✔✔Late reproductive years -3b and -3a - ✔✔-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? - ✔✔Cycle
day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
✔✔AFC - ✔✔Antral follicle count. Number of follicles that are detectable with
ultrasound.
✔✔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? - ✔✔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 region of the adrenal gland secretes the androgens? - ✔✔Zona reticularis.
✔✔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.
✔✔Menorrhagia treatment - ✔✔IUD plus estrogen patch or continuous HRT.
✔✔FPHL vs Telogen Effluvium - ✔✔FPHL is gradual, telogen effluvium is sudden and
usually precipitated by a life stressor.
✔✔FPHL pattern - ✔✔Thinning at the crown of the head and widening of the hair part.
✔✔Treating FPHL - ✔✔Minoxidil, spironolactone, finasteride.
✔✔Ethnicity least likely to have bad hot flashes - ✔✔Japanese.
✔✔Ethnicity most likely to have bad hot flashes - ✔✔Black, more frequent, longer
duration.
✔✔Median length of hot flashes - ✔✔10 years.
✔✔Theories about etiology of hot flashes - ✔✔Lower ovarian estradiol thermoregulation
zone is narrowed, neurokinins regulate GnRH secretion.
✔✔VIN low grade - ✔✔Not precancerous.
✔✔VIN high grade - ✔✔Precancerous; requires GYN ONC intervention.
✔✔Most common type of vulvar cancer - ✔✔Squamous cell carcinoma.
✔✔Vulvar disorder misdiagnosed as eczema - ✔✔Paget's disease.
✔✔Normal PVR - ✔✔<100mL.
✔✔Estrogen and urinary incontinence - ✔✔Will NOT help with stress incontinence.
✔✔Topical vaginal estrogen with highest dose - ✔✔Vaginal rings; FEMRING is the
highest.
