NAMS MENOPAUSE COMPREHENSIVE
STUDY GUIDE FULL QUESTIONS WITH
ACCURATE SOLUTIONS
●● LMP before age 45
Answer: Early menopause
●● LMP after age 54
Answer: Late menopause
●● Menopause that occurs before age 40
Answer: Primary ovarian insufficiency
●● Persistent difference of 7 days or more in the length of consecutive
cycles.
Answer: Early menopause transition (stage -2)
●● 60 or more consecutive days of amenorrhea
Answer: Late menopause transition (stage -1)
●● 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.
Answer: Luteal out of phase event (LOOP)
●● 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)
Answer: Obese women and estradiol levels during menopause
●● These ethnic groups have lower estradiol levels then white, black and
hispanic women.
Answer: Chinese and Japanese women
●● late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Answer: stage +2
●● early post menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
Answer: Stages +1a, +1b, +1c
●● Endocrine labs after menopause
,Answer: Elevated FSH, LH
●● These hormones work during reproductive years to not deplete
follicle pool too quickly.
Answer: AMH, inhibin B
●● Menstrual cycle variable, persistent >7 day difference between
difference in length of consecutive cycles.
Answer: Phases during menopause transition and PMS symptoms
●● many pitfalls, variable depending on the day of the cycle you draw
the lab, normal or low FSH is not helpful.
Answer: How to respond if a patient requests FSH lab?
●● AMH
Answer: The potentially superior marker of menopause, a lab.
●● Adrenal androgens: precursor hromones produced by the adrenal
gland that are enzymatically converted to active androgens or estrogens
in peripheral tissues.
Answer: DHEA (dehydroepiandrosterone)
●● Vagina, vulva, urethra, trigone of the bladder
, Answer: Location of estrogen receptors
●● maintain blood flow, the collagen, and HA within the epithelial
surfaces. Supports microbiome which supports acidity of vagina and
protects tissue from pathogens.
Answer: Effects of estrogen on tissue
●● Thinning, loss of elasticity, loss or absence or rugae.
Answer: Vaginal changes with menopause
●● vagina narrows, urethra moves closer to the introitus.
Answer: Vagina and urethra in menopause
●● Vaginal estrogen and urinary incontinence: what type does it help
with?
Answer: Stress urinary incontinence
●● Minoxidil, spironolactone, finasteride, estrogen therapy
Answer: Treatment for FPHL
●● -3b: menstrual cycles normal, FSH normal, AMH low, AFC low,
inhibin low.
STUDY GUIDE FULL QUESTIONS WITH
ACCURATE SOLUTIONS
●● LMP before age 45
Answer: Early menopause
●● LMP after age 54
Answer: Late menopause
●● Menopause that occurs before age 40
Answer: Primary ovarian insufficiency
●● Persistent difference of 7 days or more in the length of consecutive
cycles.
Answer: Early menopause transition (stage -2)
●● 60 or more consecutive days of amenorrhea
Answer: Late menopause transition (stage -1)
●● 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.
Answer: Luteal out of phase event (LOOP)
●● 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)
Answer: Obese women and estradiol levels during menopause
●● These ethnic groups have lower estradiol levels then white, black and
hispanic women.
Answer: Chinese and Japanese women
●● late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Answer: stage +2
●● early post menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
Answer: Stages +1a, +1b, +1c
●● Endocrine labs after menopause
,Answer: Elevated FSH, LH
●● These hormones work during reproductive years to not deplete
follicle pool too quickly.
Answer: AMH, inhibin B
●● Menstrual cycle variable, persistent >7 day difference between
difference in length of consecutive cycles.
Answer: Phases during menopause transition and PMS symptoms
●● many pitfalls, variable depending on the day of the cycle you draw
the lab, normal or low FSH is not helpful.
Answer: How to respond if a patient requests FSH lab?
●● AMH
Answer: The potentially superior marker of menopause, a lab.
●● Adrenal androgens: precursor hromones produced by the adrenal
gland that are enzymatically converted to active androgens or estrogens
in peripheral tissues.
Answer: DHEA (dehydroepiandrosterone)
●● Vagina, vulva, urethra, trigone of the bladder
, Answer: Location of estrogen receptors
●● maintain blood flow, the collagen, and HA within the epithelial
surfaces. Supports microbiome which supports acidity of vagina and
protects tissue from pathogens.
Answer: Effects of estrogen on tissue
●● Thinning, loss of elasticity, loss or absence or rugae.
Answer: Vaginal changes with menopause
●● vagina narrows, urethra moves closer to the introitus.
Answer: Vagina and urethra in menopause
●● Vaginal estrogen and urinary incontinence: what type does it help
with?
Answer: Stress urinary incontinence
●● Minoxidil, spironolactone, finasteride, estrogen therapy
Answer: Treatment for FPHL
●● -3b: menstrual cycles normal, FSH normal, AMH low, AFC low,
inhibin low.
