NAMs Menopause Certification Exam
3 reasons supporting the idea that HRT in early menopause may decrease a woman's chance
of developing Alzheimer's disease? - ANS -1. Observational studies imply it
2. Clinical trial of transdermal estradiol during the early postmenopause stage is associated with
reductions in AD pathology.
3. 18 year cumulative follow up data from WHI found that women randomized to ET had
significantly lower risk of dying from AD or dementia compared with women randomized to
receive placebo.
\AFC - ANS -Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability pool of follicles.
\Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main
factors. - ANS -Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted
by the anterior pituitary.
\all adults born from what year to what year should receive one time hep c testing? - ANS -1945
to 1965
\AMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak? - ANS -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.
\AMH, inhibin B - ANS -These hormones work during reproductive years to not deplete follicle
pool too quickly.
\Anyone <40years old who misses 3+ consecutive cycles gets these labs - ANS -prolactin
FSH
estradiol
TSH
pregnancy test
\are hot or cold thyroid nodules typically most likely to be malignant? - ANS -cold nodules
\Asians have ____BMD than white people? - ANS -lower
\atypical femur risk in women on bisphosphonate? - ANS -1 in 1000 after 2-3 years.
, \Black box warning for PTH receptor agonists? - ANS -osteosarcoma
\Black women have ____BMD than white people? - ANS -higher
\Black women have higher or lower FSH levels? - ANS -Higher
\by age 50 what percentage of US women will have acquired a genital HPV infection? - ANS
-80%-HPV is very common, but it is the high risk ones to worry about
\caution using PTH receptor agonists in what condition? - ANS -hypercalcemia
\cdc and who guidelines for migraine treatment - ANS -migraine with aura-advise to not use
combined hormone contraception
caution in women with migraine without aura
\Chinese and Japanese women - ANS -These ethnic groups have lower estradiol levels then
white, black and hispanic women.
\Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and hispanic women? - ANS -lower
\Climacteric phase - ANS -The period of endrocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
\Cortisol and HRT - ANS -Most serum cortisol circulates bound to cortisol binding globulin.
Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol concentration.
\Dairy free diet amount of calicum. How much do they need to supplement? - ANS -dairy free
diet-300mg calcium daily.
Needs 800-1200mg
\DHEA (dehydroepiandrosterone) - ANS -Adrenal androgens: precursor hromones produced by
the adrenal gland that are enzymatically converted to active androgens or estrogens in
peripheral tissues.
\Do cortisol levels associate with VMS severity? - ANS -No, cortisol levels have NOT been
associated with more severe VMS.
\Does systemic ET cause fibroids to resume growth? - ANS -Rarely. They often shrink after
menopause.
\Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B and
AMH? - ANS -inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished
follicle pool.
\Early menopause - ANS -LMP before age 45
\Early menopause transition (stage -2) - ANS -Persistent difference of 7 days or more in the
length of consecutive cycles.
\effect of HRT on cognition - ANS -small or no overall effect on cognition
3 reasons supporting the idea that HRT in early menopause may decrease a woman's chance
of developing Alzheimer's disease? - ANS -1. Observational studies imply it
2. Clinical trial of transdermal estradiol during the early postmenopause stage is associated with
reductions in AD pathology.
3. 18 year cumulative follow up data from WHI found that women randomized to ET had
significantly lower risk of dying from AD or dementia compared with women randomized to
receive placebo.
\AFC - ANS -Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability pool of follicles.
\Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main
factors. - ANS -Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted
by the anterior pituitary.
\all adults born from what year to what year should receive one time hep c testing? - ANS -1945
to 1965
\AMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak? - ANS -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.
\AMH, inhibin B - ANS -These hormones work during reproductive years to not deplete follicle
pool too quickly.
\Anyone <40years old who misses 3+ consecutive cycles gets these labs - ANS -prolactin
FSH
estradiol
TSH
pregnancy test
\are hot or cold thyroid nodules typically most likely to be malignant? - ANS -cold nodules
\Asians have ____BMD than white people? - ANS -lower
\atypical femur risk in women on bisphosphonate? - ANS -1 in 1000 after 2-3 years.
, \Black box warning for PTH receptor agonists? - ANS -osteosarcoma
\Black women have ____BMD than white people? - ANS -higher
\Black women have higher or lower FSH levels? - ANS -Higher
\by age 50 what percentage of US women will have acquired a genital HPV infection? - ANS
-80%-HPV is very common, but it is the high risk ones to worry about
\caution using PTH receptor agonists in what condition? - ANS -hypercalcemia
\cdc and who guidelines for migraine treatment - ANS -migraine with aura-advise to not use
combined hormone contraception
caution in women with migraine without aura
\Chinese and Japanese women - ANS -These ethnic groups have lower estradiol levels then
white, black and hispanic women.
\Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and hispanic women? - ANS -lower
\Climacteric phase - ANS -The period of endrocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
\Cortisol and HRT - ANS -Most serum cortisol circulates bound to cortisol binding globulin.
Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol concentration.
\Dairy free diet amount of calicum. How much do they need to supplement? - ANS -dairy free
diet-300mg calcium daily.
Needs 800-1200mg
\DHEA (dehydroepiandrosterone) - ANS -Adrenal androgens: precursor hromones produced by
the adrenal gland that are enzymatically converted to active androgens or estrogens in
peripheral tissues.
\Do cortisol levels associate with VMS severity? - ANS -No, cortisol levels have NOT been
associated with more severe VMS.
\Does systemic ET cause fibroids to resume growth? - ANS -Rarely. They often shrink after
menopause.
\Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B and
AMH? - ANS -inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished
follicle pool.
\Early menopause - ANS -LMP before age 45
\Early menopause transition (stage -2) - ANS -Persistent difference of 7 days or more in the
length of consecutive cycles.
\effect of HRT on cognition - ANS -small or no overall effect on cognition
