NAMS MENOPAUSE CERTIFICATION EXAM (MSCP) | 2026 |
VERIFIED PRACTICE QUESTIONS AND CORRECT ANSWERS |
DETAILED RATIONALES
• Early menopause -✓✓ LMP before age 45.
• Late menopause -✓✓ LMP after age 54.
• Primary ovarian insufficiency -✓✓ Menopause that occurs before age 40.
• Early menopause transition (stage -2) -✓✓ Persistent difference of 7 days or more in
the length of consecutive cycles.
• Late menopause transition (stage -1) -✓✓ 60 or more consecutive days of
amenorrhea.
• Luteal out of phase event (LOOP) -✓✓ Explains why some perimenopausal women
have elevated estrogen levels sometimes.
• Obese women and estradiol levels during menopause -✓✓ Obese women are more
likely to have anovulatory cycles with high estradiol levels.
• Chinese and Japanese women -✓✓ These ethnic groups have lower estradiol levels
than white, black, and Hispanic women.
• Stage +2 -✓✓ Late menopause stage: 5-8 years after FMP. Somatic aging
predominates.
• Stages +1a, +1b, +1c -✓✓ Early post menopause: 2 years after FMP. FSH rises,
estradiol decreases.
• Elevated FSH, LH -✓✓ Endocrine labs after menopause.
• AMH, inhibin B -✓✓ These hormones work during reproductive years to not deplete
follicle pool too quickly.
• Phases during menopause transition and PMS symptoms -✓✓ Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive
cycles.
• How to respond if a patient requests FSH lab? -✓✓ Many pitfalls, variable depending
on the day of the cycle you draw the lab.
,• The potentially superior marker of menopause, a lab. -✓✓ AMH.
• DHEA (dehydroepiandrosterone) -✓✓ Adrenal androgens: precursor hormones
produced by the adrenal gland that are enzymatically converted to active androgens or
estrogens in peripheral tissues.
• Location of estrogen receptors -✓✓ Vagina, vulva, urethra, trigone of the bladder.
• Effects of estrogen on tissue -✓✓ Maintain blood flow, the collagen, and HA within the
epithelial surfaces.
• Vaginal changes with menopause -✓✓ Thinning, loss of elasticity, loss or absence of
rugae.
• Vagina and urethra in menopause -✓✓ Vagina narrows, urethra moves closer to the
introitus.
• Stress urinary incontinence -✓✓ Vaginal estrogen and urinary incontinence: what type
does it help with?
• Treatment for FPHL -✓✓ Minoxidil, spironolactone, finasteride, estrogen therapy.
• Late reproductive years -3b and -3a -✓✓ -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? -✓✓ Cycle day
#3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
• AFC -✓✓ Antral follicle count. Number of follicles that are detectable with ultrasound.
• Late menopause transition (-1) FSH level on random draw -✓✓ 25 or higher.
• Black women have higher or lower FSH levels? -✓✓ Higher.
• Chinese and Japanese women have higher or lower estradiol levels compared to
white, black and Hispanic women? -✓✓ Lower.
• Menopause transition-changes in SHBG and testosterone? -✓✓ SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
• Testosterone/SHBG ratio is called what? -✓✓ The free androgen index.
• What stage are VMS more likely? -✓✓ +1b (generally last 2 years).
, • What hormone is generally higher in obese women? -✓✓ Estrone-via aromatization.
• The postmenopausal ovary continues to produce what two hormones? -✓✓
Testosterone and androstenedione.
• Surgical menopause causes women to have lower levels of what hormone? -✓✓
Testosterone. 40-50% lower than in women w/ intact ovaries.
• Driving piece of menopause is ovarian follicles depleting. What does this do to the
inhibin B and AMH? -✓✓ Inhibin and AMH decrease.
• In the menopause transition, women spend more time in what phase? -✓✓ Luteal-
more PMS symptoms, more frequent menstrual periods.
• HPO axis theory and the menopause transition -✓✓ It is felt that the HPO axis may
become less sensitive to estrogen.
• In the first year after the FMP, there is no production of what hormone? -✓✓
Progesterone.
• What region of the adrenal gland secretes the androgens? -✓✓ Zona reticularis.
• What are considered the 'adrenal androgens'? -✓✓ DHEA, DHEAS, Androstenedione.
• Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3
main factors. -✓✓ Angiotensin II, potassium concentration, adrenocorticotropic hormone
secreted by the anterior pituitary.
• What part of the pituitary gland secretes adrenocorticotropic hormone? -✓✓ Anterior
pituitary.
• Cortisol and HRT -✓✓ Most serum cortisol circulates bound to cortisol binding globulin.
• Do cortisol levels associate with VMS severity? -✓✓ No, cortisol levels have NOT
been associated with more severe VMS.
• Local DHEA has been proven to help with what? -✓✓ Vaginal pain and dyspareunia.
• How to DX POI? -✓✓ Menstrual disturbance-oligomenorrhea or amenorrhea for at
least 4 months and elevated FSH over 25 on two occasions at least 4 weeks apart.
• Anyone <40 years old who misses 3+ consecutive cycles gets these labs -✓✓
Prolactin, FSH, estradiol, TSH, pregnancy test.
VERIFIED PRACTICE QUESTIONS AND CORRECT ANSWERS |
DETAILED RATIONALES
• Early menopause -✓✓ LMP before age 45.
• Late menopause -✓✓ LMP after age 54.
• Primary ovarian insufficiency -✓✓ Menopause that occurs before age 40.
• Early menopause transition (stage -2) -✓✓ Persistent difference of 7 days or more in
the length of consecutive cycles.
• Late menopause transition (stage -1) -✓✓ 60 or more consecutive days of
amenorrhea.
• Luteal out of phase event (LOOP) -✓✓ Explains why some perimenopausal women
have elevated estrogen levels sometimes.
• Obese women and estradiol levels during menopause -✓✓ Obese women are more
likely to have anovulatory cycles with high estradiol levels.
• Chinese and Japanese women -✓✓ These ethnic groups have lower estradiol levels
than white, black, and Hispanic women.
• Stage +2 -✓✓ Late menopause stage: 5-8 years after FMP. Somatic aging
predominates.
• Stages +1a, +1b, +1c -✓✓ Early post menopause: 2 years after FMP. FSH rises,
estradiol decreases.
• Elevated FSH, LH -✓✓ Endocrine labs after menopause.
• AMH, inhibin B -✓✓ These hormones work during reproductive years to not deplete
follicle pool too quickly.
• Phases during menopause transition and PMS symptoms -✓✓ Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive
cycles.
• How to respond if a patient requests FSH lab? -✓✓ Many pitfalls, variable depending
on the day of the cycle you draw the lab.
,• The potentially superior marker of menopause, a lab. -✓✓ AMH.
• DHEA (dehydroepiandrosterone) -✓✓ Adrenal androgens: precursor hormones
produced by the adrenal gland that are enzymatically converted to active androgens or
estrogens in peripheral tissues.
• Location of estrogen receptors -✓✓ Vagina, vulva, urethra, trigone of the bladder.
• Effects of estrogen on tissue -✓✓ Maintain blood flow, the collagen, and HA within the
epithelial surfaces.
• Vaginal changes with menopause -✓✓ Thinning, loss of elasticity, loss or absence of
rugae.
• Vagina and urethra in menopause -✓✓ Vagina narrows, urethra moves closer to the
introitus.
• Stress urinary incontinence -✓✓ Vaginal estrogen and urinary incontinence: what type
does it help with?
• Treatment for FPHL -✓✓ Minoxidil, spironolactone, finasteride, estrogen therapy.
• Late reproductive years -3b and -3a -✓✓ -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? -✓✓ Cycle day
#3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
• AFC -✓✓ Antral follicle count. Number of follicles that are detectable with ultrasound.
• Late menopause transition (-1) FSH level on random draw -✓✓ 25 or higher.
• Black women have higher or lower FSH levels? -✓✓ Higher.
• Chinese and Japanese women have higher or lower estradiol levels compared to
white, black and Hispanic women? -✓✓ Lower.
• Menopause transition-changes in SHBG and testosterone? -✓✓ SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
• Testosterone/SHBG ratio is called what? -✓✓ The free androgen index.
• What stage are VMS more likely? -✓✓ +1b (generally last 2 years).
, • What hormone is generally higher in obese women? -✓✓ Estrone-via aromatization.
• The postmenopausal ovary continues to produce what two hormones? -✓✓
Testosterone and androstenedione.
• Surgical menopause causes women to have lower levels of what hormone? -✓✓
Testosterone. 40-50% lower than in women w/ intact ovaries.
• Driving piece of menopause is ovarian follicles depleting. What does this do to the
inhibin B and AMH? -✓✓ Inhibin and AMH decrease.
• In the menopause transition, women spend more time in what phase? -✓✓ Luteal-
more PMS symptoms, more frequent menstrual periods.
• HPO axis theory and the menopause transition -✓✓ It is felt that the HPO axis may
become less sensitive to estrogen.
• In the first year after the FMP, there is no production of what hormone? -✓✓
Progesterone.
• What region of the adrenal gland secretes the androgens? -✓✓ Zona reticularis.
• What are considered the 'adrenal androgens'? -✓✓ DHEA, DHEAS, Androstenedione.
• Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3
main factors. -✓✓ Angiotensin II, potassium concentration, adrenocorticotropic hormone
secreted by the anterior pituitary.
• What part of the pituitary gland secretes adrenocorticotropic hormone? -✓✓ Anterior
pituitary.
• Cortisol and HRT -✓✓ Most serum cortisol circulates bound to cortisol binding globulin.
• Do cortisol levels associate with VMS severity? -✓✓ No, cortisol levels have NOT
been associated with more severe VMS.
• Local DHEA has been proven to help with what? -✓✓ Vaginal pain and dyspareunia.
• How to DX POI? -✓✓ Menstrual disturbance-oligomenorrhea or amenorrhea for at
least 4 months and elevated FSH over 25 on two occasions at least 4 weeks apart.
• Anyone <40 years old who misses 3+ consecutive cycles gets these labs -✓✓
Prolactin, FSH, estradiol, TSH, pregnancy test.
