NAMS MENOPAUSE CERTIFICATION EXAM 2024
secondary causes of osteoporosis
which 3 common drugs? - Answers-Hyperthyroidism, hyperparathyroidism,
hypercalciuria, certain drugs (eg: tamoxifen, steroids, PPIs), calcium/vitamin D
deficiency, RA, celiac disease, malabsorptive diseases such as Crohn disease, and
ulcerative colitis
Median age of menopause in US women - Answers-52.54 y
POI - Answers-Intermittent ovarian function & insufficient estrogen levels occurring at
age <40 y
which STRAW stage?
menarche / early reproductive - Answers--5
which STRAW stage?
peak reproductive - Answers--4
which STRAW stage?
late reproductive - Answers--3
which STRAW stage?
perimenopause - Answers--2 to -1 & +1a
which STRAW stage?
FMP &
12 months after final menstrual period - Answers-FMP = 0
12 months after = +1a
which STRAW stage?
VMS most likely - Answers-+1a (most likely)
-1 (likely)
aka perimenopause/menopause transition
which STRAW stage?
early post menopause - Answers-+1a to +1c
,which STRAW stage?
late postmenopause - Answers-+2
which STRAW stage?
amenorrhea >60 days - Answers--1
aka late menopause transition
which STRAW stage?
variable cycle lengths of >7 days differences - Answers--2
aka early menopause transition
difference between menopause transition vs perimenopause per STRAW criteria? -
Answers-menopause transition: -2 and -1, prior to FMP
perimenopause: -2 to +1a, includes 12 mo of amenorrhea following FMP
which STRAW stage?
initial drop in AMH/AFC/inhibin, cycles still regular, FSH normal - Answers--3b
aka late reproductive
which STRAW stage?
cycles shorter, first increase in FSH - Answers--3a
aka late reproductive
levels spike with ovulation, marker of ovarian reserve - Answers-inhibin B
Produced by granulosa cells of activated follicles, most reflective of true ovarian
reserve; provides the best single prediction of time to menopause - Answers-AMH
what day of cycle to draw FSH to predict ovarian response/reserve? - Answers-day 3
normal day 3 FSH?
FSH value for menopause? - Answers-< 10
>25
# of ultrasound detected follicles 2-10 mm in size - Answers-AFC (antral follicle count)
, normal AFC - Answers->12
Luteal-Out-Of-Phase (LOOP) event - Answers-- FSH elevation recruits follicles for the
subsequent cycle before the current cycle is over
- Excess estradiol production as new follicles start growing
- Increase chance of TWINS
- Very short follicular phase
- More time spent in luteal phase (more PMS/PMDD sx)
symptoms of LOOP event - Answers-—Mastalgia
—Worsening migraine
—Growing fibroids
—Risk of endometrial hyperplasia
- longer time in luteal phase (worsening PMDD in peri)
premenopausal vs postmenopausal estradiol levels in obesity - Answers-pre: lower,
more anovulatory cycles
post: higher
consequence of inhibin B and AMH drop in early menopause transition? - Answers-FSH
spikes --> fast growth of remaining follicles (twins more likely) --> shorter follicular
phase --> follicle atresia --> LOOP cycles --> pronounced PMS sx from longer luteal
phase --> cycle irregularity by >7 days
dec ovarian reserve causes the drop in what 2 hormones? - Answers-inhibin B and AMH
4 adrenal androgens - Answers-—Dehydroepiandrosterone (DHEA)
—Dehydroepiandrosterone sulfate (DHEAS)
—Androstenedione
—Testosterone
where are adrenal androgens converted to estrogen? - Answers-peripheral tissue
what happens to DHEA levels during menopause transition? - Answers-transient
increase then return to premenopause baseline
is DHEA supplementation in menopause recommended? - Answers-no
(Systematic review and meta-analysis of DHEA use in postmenopausal women with
normal adrenal function found no evidence of improvement in sexual symptoms, serum
lipids, serum glucose, weight, or bone mineral density)
dx of POI? - Answers-amenorrhea >4 mo in age <40
FSH >25 on 2 occasions
secondary causes of osteoporosis
which 3 common drugs? - Answers-Hyperthyroidism, hyperparathyroidism,
hypercalciuria, certain drugs (eg: tamoxifen, steroids, PPIs), calcium/vitamin D
deficiency, RA, celiac disease, malabsorptive diseases such as Crohn disease, and
ulcerative colitis
Median age of menopause in US women - Answers-52.54 y
POI - Answers-Intermittent ovarian function & insufficient estrogen levels occurring at
age <40 y
which STRAW stage?
menarche / early reproductive - Answers--5
which STRAW stage?
peak reproductive - Answers--4
which STRAW stage?
late reproductive - Answers--3
which STRAW stage?
perimenopause - Answers--2 to -1 & +1a
which STRAW stage?
FMP &
12 months after final menstrual period - Answers-FMP = 0
12 months after = +1a
which STRAW stage?
VMS most likely - Answers-+1a (most likely)
-1 (likely)
aka perimenopause/menopause transition
which STRAW stage?
early post menopause - Answers-+1a to +1c
,which STRAW stage?
late postmenopause - Answers-+2
which STRAW stage?
amenorrhea >60 days - Answers--1
aka late menopause transition
which STRAW stage?
variable cycle lengths of >7 days differences - Answers--2
aka early menopause transition
difference between menopause transition vs perimenopause per STRAW criteria? -
Answers-menopause transition: -2 and -1, prior to FMP
perimenopause: -2 to +1a, includes 12 mo of amenorrhea following FMP
which STRAW stage?
initial drop in AMH/AFC/inhibin, cycles still regular, FSH normal - Answers--3b
aka late reproductive
which STRAW stage?
cycles shorter, first increase in FSH - Answers--3a
aka late reproductive
levels spike with ovulation, marker of ovarian reserve - Answers-inhibin B
Produced by granulosa cells of activated follicles, most reflective of true ovarian
reserve; provides the best single prediction of time to menopause - Answers-AMH
what day of cycle to draw FSH to predict ovarian response/reserve? - Answers-day 3
normal day 3 FSH?
FSH value for menopause? - Answers-< 10
>25
# of ultrasound detected follicles 2-10 mm in size - Answers-AFC (antral follicle count)
, normal AFC - Answers->12
Luteal-Out-Of-Phase (LOOP) event - Answers-- FSH elevation recruits follicles for the
subsequent cycle before the current cycle is over
- Excess estradiol production as new follicles start growing
- Increase chance of TWINS
- Very short follicular phase
- More time spent in luteal phase (more PMS/PMDD sx)
symptoms of LOOP event - Answers-—Mastalgia
—Worsening migraine
—Growing fibroids
—Risk of endometrial hyperplasia
- longer time in luteal phase (worsening PMDD in peri)
premenopausal vs postmenopausal estradiol levels in obesity - Answers-pre: lower,
more anovulatory cycles
post: higher
consequence of inhibin B and AMH drop in early menopause transition? - Answers-FSH
spikes --> fast growth of remaining follicles (twins more likely) --> shorter follicular
phase --> follicle atresia --> LOOP cycles --> pronounced PMS sx from longer luteal
phase --> cycle irregularity by >7 days
dec ovarian reserve causes the drop in what 2 hormones? - Answers-inhibin B and AMH
4 adrenal androgens - Answers-—Dehydroepiandrosterone (DHEA)
—Dehydroepiandrosterone sulfate (DHEAS)
—Androstenedione
—Testosterone
where are adrenal androgens converted to estrogen? - Answers-peripheral tissue
what happens to DHEA levels during menopause transition? - Answers-transient
increase then return to premenopause baseline
is DHEA supplementation in menopause recommended? - Answers-no
(Systematic review and meta-analysis of DHEA use in postmenopausal women with
normal adrenal function found no evidence of improvement in sexual symptoms, serum
lipids, serum glucose, weight, or bone mineral density)
dx of POI? - Answers-amenorrhea >4 mo in age <40
FSH >25 on 2 occasions
