NAMS Certification Knowledge Check
with Complete Solutions 2025-2026
NAMS Certification Knowledge Check
with Complete Solutions 2025-2026
Summarize the physiology of natural menopause and describe the recommendation for or
against laboratory confirmation of menopause correct answers Menopause is defined as the
point in time at which menstruation has ceased for a full year. In the peri-menopausal period
leading up to this time, i tis common for cycles to become erratic due to normal physiologic
changes to the hypothalamic-pituitary-ovarian axis. The developing ovarian follicles are less
responsive to FSH and the ovaries produce less estradiol, progesterone, and androgens.
Normally, high levels of estrogen and progesterone serve as a negative feedback loop on the
hypothalamus, keeping production of gonadotropin-releasing hormone (GnRH) low.
However, as estrogen and progesterone levels decrease, this eliminates the usual negative
feedback effect and thus GnRH is high and FSH/LH from the anterior pituitary is thus high.
During this transition, hormone levels can fluctuate wildly from day to day, which makes
measuring hormones during this time difficult to interpret and is not recommended in most
cases.
Due to the established risk for breast cancer, estrogen-progesterone therapy for menopausal
symptoms should be limited to _________ years of use. correct answers 3-5 years
The addition of progesterone to estrogen hormone therapy was developed to lower the risk
of.... correct answers endometrial hyperplasia and cancer
Describe the 3 type of estrogens and where they are produced. correct answers E1 = estrone,
the weakest estrogen, primary estrogen present in post-menopausal females, children, and
males. In the post-menopausal period, 5% is produced by the ovaries by 95% is produced by
adipose-conversion of androstenedione secreted by the adrenals
E2 = estradiol, most potent estrogen, main estrogen produced during the female reproductive
years by the ovaries
E3 = estriol, secreted by the placenta, present in non-pregnant females only in small amounts
as a by-product of estradiol and estrone
Describe the production of testosterone in post-menopausal females and the pattern of its
level throughout the menopausal transition correct answers Although the ovaries of post-
menopausal females no longer produce estrogen or functional follicles after menopause, the
corticostromal and hilar cells of the stromal tissue are still steroidogenic and produce
androstenedione and testosterone. Circulating levels of testosterone thus remain relatively
constant before and after menopause, due to the presence of high FSH/LH that marks
menopause which acts to stimulate the ovaries to increase testosterone production
Age of natural menopause, range and average correct answers average 52, range 40-58
Succinct explanation of the relationship of body fat to estrogen levels correct answers
Adipose tissue stores androstenedione, and converts it to estrogen.
, NAMS Certification Knowledge Check
with Complete Solutions 2025-2026
Succinct explanation of what anti-mullerian hormone (AMH) is a marker of on lab studies
correct answers AMH is a marker of ovarian reserve, and reflects the number of remaining
follicles
Selective laboratory testing to consider in females presenting with suspected menopause-
related symptoms to rule out other contributing conditions correct answers CBC, fasting
glucose, TSH, prolactin
Anticipatory guidance on expected duration of menopausal symptoms correct answers Most
symptoms begin in the perimenopausal period and increase in severity during the early post-
menopausal period, peaking in the first 2 years after menopause. Most symptomatic females
will experience symptoms on average for as long as 5 years after menopause and
approximately 1/3 of women will experience symptoms for 10 years or more. Vasomotor
symptoms last 7.4 years on average. In most women, hot flashes will eventually resolve over
time without medication.
Succinct explanation of why there is increased risk for UTIs post-menopause. correct answers
There are reduced lactobacilli populations in the female vagina after menopause, which
effectively increases the vaginal pH (pre-menopause, is more acidic), which increases the risk
of infection
Primary care conditions that women are at increased risk for post-menopause (3) correct
answers heart disease, osteoporosis, diabetes
% of females who will develop breast cancer in their lifetime correct answers 12% (1 in 8)
How much calcium and vitamin D should be recommended to post-menopausal females?
correct answers From all sources -
calcium = 1,200 mg/day
vitamin D = 800=1,000 units/day (organizational recommendations vary, 600 units - 2,000
units per day)
How to use the FRAX score to determine if post-menopausal females are good candidates for
medication therapy? correct answers If the hip fracture probability is equal to or greater than
3%, or if the risk of ANY major osteoporotic fracture is equal to or greater than 20%,
medication therapy is recommended
How often do post-menopausal females on osteoporosis medication therapy need repeat DXA
testing? correct answers Q2 years (per NOF, 2014)
What are the medication options for treating postmenopausal osteoporosis correct answers -
bisphosphonates (alendronate [Fosamax], risendronate [Actonel], ibandronate [Boniva])
- zoledronic acid (Reclast)
- calcitonin
- estrogen (i.e., Premarin, Estrace)
- raloxifene (Evista)
- teriparatide (Forteo)
with Complete Solutions 2025-2026
NAMS Certification Knowledge Check
with Complete Solutions 2025-2026
Summarize the physiology of natural menopause and describe the recommendation for or
against laboratory confirmation of menopause correct answers Menopause is defined as the
point in time at which menstruation has ceased for a full year. In the peri-menopausal period
leading up to this time, i tis common for cycles to become erratic due to normal physiologic
changes to the hypothalamic-pituitary-ovarian axis. The developing ovarian follicles are less
responsive to FSH and the ovaries produce less estradiol, progesterone, and androgens.
Normally, high levels of estrogen and progesterone serve as a negative feedback loop on the
hypothalamus, keeping production of gonadotropin-releasing hormone (GnRH) low.
However, as estrogen and progesterone levels decrease, this eliminates the usual negative
feedback effect and thus GnRH is high and FSH/LH from the anterior pituitary is thus high.
During this transition, hormone levels can fluctuate wildly from day to day, which makes
measuring hormones during this time difficult to interpret and is not recommended in most
cases.
Due to the established risk for breast cancer, estrogen-progesterone therapy for menopausal
symptoms should be limited to _________ years of use. correct answers 3-5 years
The addition of progesterone to estrogen hormone therapy was developed to lower the risk
of.... correct answers endometrial hyperplasia and cancer
Describe the 3 type of estrogens and where they are produced. correct answers E1 = estrone,
the weakest estrogen, primary estrogen present in post-menopausal females, children, and
males. In the post-menopausal period, 5% is produced by the ovaries by 95% is produced by
adipose-conversion of androstenedione secreted by the adrenals
E2 = estradiol, most potent estrogen, main estrogen produced during the female reproductive
years by the ovaries
E3 = estriol, secreted by the placenta, present in non-pregnant females only in small amounts
as a by-product of estradiol and estrone
Describe the production of testosterone in post-menopausal females and the pattern of its
level throughout the menopausal transition correct answers Although the ovaries of post-
menopausal females no longer produce estrogen or functional follicles after menopause, the
corticostromal and hilar cells of the stromal tissue are still steroidogenic and produce
androstenedione and testosterone. Circulating levels of testosterone thus remain relatively
constant before and after menopause, due to the presence of high FSH/LH that marks
menopause which acts to stimulate the ovaries to increase testosterone production
Age of natural menopause, range and average correct answers average 52, range 40-58
Succinct explanation of the relationship of body fat to estrogen levels correct answers
Adipose tissue stores androstenedione, and converts it to estrogen.
, NAMS Certification Knowledge Check
with Complete Solutions 2025-2026
Succinct explanation of what anti-mullerian hormone (AMH) is a marker of on lab studies
correct answers AMH is a marker of ovarian reserve, and reflects the number of remaining
follicles
Selective laboratory testing to consider in females presenting with suspected menopause-
related symptoms to rule out other contributing conditions correct answers CBC, fasting
glucose, TSH, prolactin
Anticipatory guidance on expected duration of menopausal symptoms correct answers Most
symptoms begin in the perimenopausal period and increase in severity during the early post-
menopausal period, peaking in the first 2 years after menopause. Most symptomatic females
will experience symptoms on average for as long as 5 years after menopause and
approximately 1/3 of women will experience symptoms for 10 years or more. Vasomotor
symptoms last 7.4 years on average. In most women, hot flashes will eventually resolve over
time without medication.
Succinct explanation of why there is increased risk for UTIs post-menopause. correct answers
There are reduced lactobacilli populations in the female vagina after menopause, which
effectively increases the vaginal pH (pre-menopause, is more acidic), which increases the risk
of infection
Primary care conditions that women are at increased risk for post-menopause (3) correct
answers heart disease, osteoporosis, diabetes
% of females who will develop breast cancer in their lifetime correct answers 12% (1 in 8)
How much calcium and vitamin D should be recommended to post-menopausal females?
correct answers From all sources -
calcium = 1,200 mg/day
vitamin D = 800=1,000 units/day (organizational recommendations vary, 600 units - 2,000
units per day)
How to use the FRAX score to determine if post-menopausal females are good candidates for
medication therapy? correct answers If the hip fracture probability is equal to or greater than
3%, or if the risk of ANY major osteoporotic fracture is equal to or greater than 20%,
medication therapy is recommended
How often do post-menopausal females on osteoporosis medication therapy need repeat DXA
testing? correct answers Q2 years (per NOF, 2014)
What are the medication options for treating postmenopausal osteoporosis correct answers -
bisphosphonates (alendronate [Fosamax], risendronate [Actonel], ibandronate [Boniva])
- zoledronic acid (Reclast)
- calcitonin
- estrogen (i.e., Premarin, Estrace)
- raloxifene (Evista)
- teriparatide (Forteo)
