NAMs Menopause Certification Exam Effects of estrogen on tissue - ANSWER maintain blood flow, the collagen, and HA
within the epithelial surfaces. Supports microbiome which supports acidity of vagina and
Sample Questions with Approved Answers |Latest protects tissue from pathogens.
2024/2025
Vaginal changes with menopause - ANSWER Thinning, loss of elasticity, loss or
absence or rugae.
Obese women and estradiol levels during menopause - ANSWER Obese women are
more likely to have anovulatory cycles with high estradiol levels. They are also more Vagina and urethra in menopause - ANSWER vagina narrows, urethra moves closer to
likely to have lower premenopause yet higher postmenopause estradiol levels the introitus.
compared with women of normal weight. (why they are at higher risk of endometrial
cancer) Stress urinary incontinence - ANSWER Vaginal estrogen and urinary incontinence:
what type does it help with?
Chinese and Japanese women - ANSWER These ethnic groups have lower estradiol
levels then white, black and hispanic women. Treatment for FPHL - ANSWER Minoxidil, spironolactone, finasteride, estrogen therapy
stage +2 - ANSWER late menopause stage: 5-8 years after FMP. Somatic aging Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH,
predominates. Increased genitourinary symptoms. AFC, inhibin? - ANSWER -3b: menstrual cycles normal, FSH normal, AMH low, AFC
low, inhibin low.
Stages +1a, +1b, +1c - ANSWER early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate. -3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low.
Elevated FSH, LH - ANSWER Endocrine labs after menopause When it is appropriate to check an FSH during the cycle if you check it? and why? -
ANSWER Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal
AMH, inhibin B - ANSWER These hormones work during reproductive years to not FSH level.
deplete follicle pool too quickly.
AMH
produced by... used
Phases during menopause transition and PMS symptoms - ANSWER Menstrual cycle
to test...
variable, persistent >7 day difference between difference in length of consecutive
Is it a screening tool for fertility?
cycles.
When does it peak? - ANSWER produced by granulosa cells
How to respond if a patient requests FSH lab? - ANSWER many pitfalls, variable
used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low
depending on the day of the cycle you draw the lab, normal or low FSH is not helpful.
ovarian reserve.
The potentially superior marker of menopause, a lab. - ANSWER AMH
not recommended as a screening tool to predict fertility.
DHEA (dehydroepiandrosterone) - ANSWER Adrenal androgens: precursor hromones
Peaks at around 25 years old. So before age 25, this test is not helpful.
produced by the adrenal gland that are enzymatically converted to active androgens or
estrogens in peripheral tissues.
It is influenced by exogenous hormones. Lower in hormonal contraception users, but
increases after d/cing.
Location of estrogen receptors - ANSWER Vagina, vulva, urethra, trigone of the
bladder
, AFC - ANSWER Antral follicle count progesterone
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability pool of follicles. What region of the adrenal gland secretes the androgens? - ANSWER zona reticularis
Late menopause transition (-1) FSH level on random draw - ANSWER 25 or higher what are considered the 'adrenal androgens'? - ANSWER DHEA, DHEAS,
Androstenedione.
Black women have higher or lower FSH levels? - ANSWER Higher
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3
Chinese and Japanese women have higher or lower estradiol levels compared to white, main factors. - ANSWER Angiotensin II, potassium concentration, adrenocorticotropic
black and hispanic women? - ANSWER lower hormone secreted by the anterior pituitary.
Menopause transition-changes in SHBG and testosterone? ratio? - ANSWER SHBG What part of the pituitary gland secretes adrenocorticotropic hormone? - ANSWER
decreases Anterior pituitary. The posterior only secretes vasopressin and oxytosin.
Testosterone/SHBG ratio increases by 80%.
Climacteric phase - ANSWER The period of endrocrinologic, somatic, and transitory
Testosterone/SHGB ratio is called what? - ANSWER The free androgen index psychologic changes that occur around the time of menopause.
What stage are VMS more likely? - ANSWER +1b (generally last 2 years) Early menopause - ANSWER LMP before age 45
What hormone is generally higher in obese women? - ANSWER Estrone-via Late menopause - ANSWER LMP after age 54
aromatization.
Primary ovarian insufficiency - ANSWER Menopause that occurs before age 40
The postmenopausal ovary continues to produce what two hormones? - ANSWER
testosterone and androstenedione Early menopause transition (stage -2) - ANSWER Persistent difference of 7 days or
more in the length of consecutive cycles.
Surgical menopause causes women to have lower levels of what hormone? - ANSWER
testosterone. 40-50% lower than in women w/ intact ovaries. Late menopause transition (stage -1) - ANSWER 60 or more consecutive days of
amenorrhea
Driving piece of menopause is ovarian follicles depleting. What does this do to the
inhibin B and AMH? - ANSWER inhibin and AMH decrease Luteal out of phase event (LOOP) - ANSWER Explains why some perimenopausal
women have elevated estrogen level sometimes...In the early menopause transition,
therefore, follicle growth is not restrained, this allows for the growth of the remaining, elevated FSH levels are adequate to recruit a second follicle which results in a follicular
diminished follicle pool. phase-like rise in estradiol secretion superimposed on the mid-to-late luteal phase of the
ongoing ovulatory cycle.
In the menopause transition, women spend more time in what phase? - ANSWER
Luteal-more PMS symptoms, more frequent menstrual periods.
Cortisol and HRT - ANSWER Most serum cortisol circulates bound to cortisol binding
HPO axis theory and the menopause transition - ANSWER It is felt that the HPO axis globulin.
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. Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
In the first year after the FMP, there is no production of what hormone? - ANSWER
within the epithelial surfaces. Supports microbiome which supports acidity of vagina and
Sample Questions with Approved Answers |Latest protects tissue from pathogens.
2024/2025
Vaginal changes with menopause - ANSWER Thinning, loss of elasticity, loss or
absence or rugae.
Obese women and estradiol levels during menopause - ANSWER Obese women are
more likely to have anovulatory cycles with high estradiol levels. They are also more Vagina and urethra in menopause - ANSWER vagina narrows, urethra moves closer to
likely to have lower premenopause yet higher postmenopause estradiol levels the introitus.
compared with women of normal weight. (why they are at higher risk of endometrial
cancer) Stress urinary incontinence - ANSWER Vaginal estrogen and urinary incontinence:
what type does it help with?
Chinese and Japanese women - ANSWER These ethnic groups have lower estradiol
levels then white, black and hispanic women. Treatment for FPHL - ANSWER Minoxidil, spironolactone, finasteride, estrogen therapy
stage +2 - ANSWER late menopause stage: 5-8 years after FMP. Somatic aging Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH,
predominates. Increased genitourinary symptoms. AFC, inhibin? - ANSWER -3b: menstrual cycles normal, FSH normal, AMH low, AFC
low, inhibin low.
Stages +1a, +1b, +1c - ANSWER early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate. -3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low.
Elevated FSH, LH - ANSWER Endocrine labs after menopause When it is appropriate to check an FSH during the cycle if you check it? and why? -
ANSWER Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal
AMH, inhibin B - ANSWER These hormones work during reproductive years to not FSH level.
deplete follicle pool too quickly.
AMH
produced by... used
Phases during menopause transition and PMS symptoms - ANSWER Menstrual cycle
to test...
variable, persistent >7 day difference between difference in length of consecutive
Is it a screening tool for fertility?
cycles.
When does it peak? - ANSWER produced by granulosa cells
How to respond if a patient requests FSH lab? - ANSWER many pitfalls, variable
used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low
depending on the day of the cycle you draw the lab, normal or low FSH is not helpful.
ovarian reserve.
The potentially superior marker of menopause, a lab. - ANSWER AMH
not recommended as a screening tool to predict fertility.
DHEA (dehydroepiandrosterone) - ANSWER Adrenal androgens: precursor hromones
Peaks at around 25 years old. So before age 25, this test is not helpful.
produced by the adrenal gland that are enzymatically converted to active androgens or
estrogens in peripheral tissues.
It is influenced by exogenous hormones. Lower in hormonal contraception users, but
increases after d/cing.
Location of estrogen receptors - ANSWER Vagina, vulva, urethra, trigone of the
bladder
, AFC - ANSWER Antral follicle count progesterone
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability pool of follicles. What region of the adrenal gland secretes the androgens? - ANSWER zona reticularis
Late menopause transition (-1) FSH level on random draw - ANSWER 25 or higher what are considered the 'adrenal androgens'? - ANSWER DHEA, DHEAS,
Androstenedione.
Black women have higher or lower FSH levels? - ANSWER Higher
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3
Chinese and Japanese women have higher or lower estradiol levels compared to white, main factors. - ANSWER Angiotensin II, potassium concentration, adrenocorticotropic
black and hispanic women? - ANSWER lower hormone secreted by the anterior pituitary.
Menopause transition-changes in SHBG and testosterone? ratio? - ANSWER SHBG What part of the pituitary gland secretes adrenocorticotropic hormone? - ANSWER
decreases Anterior pituitary. The posterior only secretes vasopressin and oxytosin.
Testosterone/SHBG ratio increases by 80%.
Climacteric phase - ANSWER The period of endrocrinologic, somatic, and transitory
Testosterone/SHGB ratio is called what? - ANSWER The free androgen index psychologic changes that occur around the time of menopause.
What stage are VMS more likely? - ANSWER +1b (generally last 2 years) Early menopause - ANSWER LMP before age 45
What hormone is generally higher in obese women? - ANSWER Estrone-via Late menopause - ANSWER LMP after age 54
aromatization.
Primary ovarian insufficiency - ANSWER Menopause that occurs before age 40
The postmenopausal ovary continues to produce what two hormones? - ANSWER
testosterone and androstenedione Early menopause transition (stage -2) - ANSWER Persistent difference of 7 days or
more in the length of consecutive cycles.
Surgical menopause causes women to have lower levels of what hormone? - ANSWER
testosterone. 40-50% lower than in women w/ intact ovaries. Late menopause transition (stage -1) - ANSWER 60 or more consecutive days of
amenorrhea
Driving piece of menopause is ovarian follicles depleting. What does this do to the
inhibin B and AMH? - ANSWER inhibin and AMH decrease Luteal out of phase event (LOOP) - ANSWER Explains why some perimenopausal
women have elevated estrogen level sometimes...In the early menopause transition,
therefore, follicle growth is not restrained, this allows for the growth of the remaining, elevated FSH levels are adequate to recruit a second follicle which results in a follicular
diminished follicle pool. phase-like rise in estradiol secretion superimposed on the mid-to-late luteal phase of the
ongoing ovulatory cycle.
In the menopause transition, women spend more time in what phase? - ANSWER
Luteal-more PMS symptoms, more frequent menstrual periods.
Cortisol and HRT - ANSWER Most serum cortisol circulates bound to cortisol binding
HPO axis theory and the menopause transition - ANSWER It is felt that the HPO axis globulin.
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. Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
In the first year after the FMP, there is no production of what hormone? - ANSWER
