NAMs Menopause Certification Exam 2024 Questions
with complete solution
Climacteric phase - Correct Answer - The period of endrocrinologic, somatic, and transitory psychologic changes that occur
around the time of menopause.
Early menopause - Correct Answer - LMP before age 45
Late menopause - Correct Answer - LMP after age 54
Primary ovarian insufficiency - Correct Answer - Menopause that occurs before age 40
Early menopause transition (stage -2) - Correct Answer - Persistent difference of 7 days or more in the length of consecutive
cycles.
Late menopause transition (stage -1) - Correct Answer - 60 or more consecutive days of amenorrhea
Luteal out of phase event (LOOP) - Correct Answer - 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.
Obese women and estradiol levels during menopause - Correct Answer - 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 level
compared with women of normal weight. (why they are at higher risk of endometrial cancer)
Chinese and Japanese women - Correct Answer - These ethnic groups have lower estradiol levels then white, black and hispanic
women.
stage +2 - Correct Answer - late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary
symptoms.
Stages +1a, +1b, +1c - Correct Answer - early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS
predominate.
Elevated FSH, LH - Correct Answer - Endocrine labs after menopause
AMH, inhibin B - Correct Answer - These hormones work during reproductive years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms - Correct Answer - Menstrual cycle shortenes, follicular phase
compresses, women spend more time in luteal phase.. meaning more premenstrual symptoms and more frequent menstrual
periods.
How to respond if a patient requests FSH lab? - Correct Answer - many pitfalls, variable depending on the day of the cycle you
draw the lab, normal or low FSH is not helpful.
The potentially superior marker of menopause, a lab. - Correct Answer - AMH
DHEA (dehydroepiandrosterone) - Correct Answer - Adrenal androgens: precursor hromones produced by the adrenal gland that
are enzymatically converted to active androgens or estrogens in peripheral tissues.
, Location of estrogen receptors - Correct Answer - Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - Correct Answer - maintain blood flow, the collagen, and HA within the epithelial surfaces.
Supports microbiome and protects tissue from pathogens.
Vaginal changes with menopause - Correct Answer - Thinning, loss of elasticity, loss or absence or rugae.
Vagina and urethra in menopause - Correct Answer - vagina narrows, urethra moves closer to the introitus.
Stress urinary incontinence - Correct Answer - Vaginal estrogen and urinary incontinence: what type does it help with?
Treatment for FPHL - Correct Answer - Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? - Correct Answer - -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? and why? - Correct Answer - Cycle day #3. Elevated
estradiol can suppress FSH giving a falsely normal FSH level.
AMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak? - Correct Answer - produced by granulosa cells
used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low ovarian reserve.
not recommended as a screening tool to predict fertility.
Peaks at around 25 years old. So before age 25, this test is not helpful.
It is influenced by exogenous hormones. Lower in hormonal contraception users, but increases after d/cing.
AFC - Correct Answer - Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability poo of follicles.
Late menopause transition (-1) FSH level on random draw - Correct Answer - 25 or higher
Black women have higher or lower FSH levels? - Correct Answer - Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic women? - Correct
Answer - lower
Menopause transition-changes in SHBG and testosterone? ratio? - Correct Answer - SHBG decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what? - Correct Answer - The free androgen index
What stage are VMS more likely? - Correct Answer - +1b (generally last 2 years)
What hormone is generally higher in obese women? - Correct Answer - Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones? - Correct Answer - testosterone and androstenedione
Surgical menopause causes women to have lower levels of what hormone? - Correct Answer - testosterone. 40-50% lower than i
women w/ intact ovaries.
with complete solution
Climacteric phase - Correct Answer - The period of endrocrinologic, somatic, and transitory psychologic changes that occur
around the time of menopause.
Early menopause - Correct Answer - LMP before age 45
Late menopause - Correct Answer - LMP after age 54
Primary ovarian insufficiency - Correct Answer - Menopause that occurs before age 40
Early menopause transition (stage -2) - Correct Answer - Persistent difference of 7 days or more in the length of consecutive
cycles.
Late menopause transition (stage -1) - Correct Answer - 60 or more consecutive days of amenorrhea
Luteal out of phase event (LOOP) - Correct Answer - 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.
Obese women and estradiol levels during menopause - Correct Answer - 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 level
compared with women of normal weight. (why they are at higher risk of endometrial cancer)
Chinese and Japanese women - Correct Answer - These ethnic groups have lower estradiol levels then white, black and hispanic
women.
stage +2 - Correct Answer - late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary
symptoms.
Stages +1a, +1b, +1c - Correct Answer - early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS
predominate.
Elevated FSH, LH - Correct Answer - Endocrine labs after menopause
AMH, inhibin B - Correct Answer - These hormones work during reproductive years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms - Correct Answer - Menstrual cycle shortenes, follicular phase
compresses, women spend more time in luteal phase.. meaning more premenstrual symptoms and more frequent menstrual
periods.
How to respond if a patient requests FSH lab? - Correct Answer - many pitfalls, variable depending on the day of the cycle you
draw the lab, normal or low FSH is not helpful.
The potentially superior marker of menopause, a lab. - Correct Answer - AMH
DHEA (dehydroepiandrosterone) - Correct Answer - Adrenal androgens: precursor hromones produced by the adrenal gland that
are enzymatically converted to active androgens or estrogens in peripheral tissues.
, Location of estrogen receptors - Correct Answer - Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - Correct Answer - maintain blood flow, the collagen, and HA within the epithelial surfaces.
Supports microbiome and protects tissue from pathogens.
Vaginal changes with menopause - Correct Answer - Thinning, loss of elasticity, loss or absence or rugae.
Vagina and urethra in menopause - Correct Answer - vagina narrows, urethra moves closer to the introitus.
Stress urinary incontinence - Correct Answer - Vaginal estrogen and urinary incontinence: what type does it help with?
Treatment for FPHL - Correct Answer - Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? - Correct Answer - -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? and why? - Correct Answer - Cycle day #3. Elevated
estradiol can suppress FSH giving a falsely normal FSH level.
AMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak? - Correct Answer - produced by granulosa cells
used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low ovarian reserve.
not recommended as a screening tool to predict fertility.
Peaks at around 25 years old. So before age 25, this test is not helpful.
It is influenced by exogenous hormones. Lower in hormonal contraception users, but increases after d/cing.
AFC - Correct Answer - Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability poo of follicles.
Late menopause transition (-1) FSH level on random draw - Correct Answer - 25 or higher
Black women have higher or lower FSH levels? - Correct Answer - Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic women? - Correct
Answer - lower
Menopause transition-changes in SHBG and testosterone? ratio? - Correct Answer - SHBG decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what? - Correct Answer - The free androgen index
What stage are VMS more likely? - Correct Answer - +1b (generally last 2 years)
What hormone is generally higher in obese women? - Correct Answer - Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones? - Correct Answer - testosterone and androstenedione
Surgical menopause causes women to have lower levels of what hormone? - Correct Answer - testosterone. 40-50% lower than i
women w/ intact ovaries.
