NAMS MENOPAUSE
CERTIFICATION EXAM
ACTUAL EXAM COMPLETE
QUESTIONS WITH VERIFIED
ANSWERS 2025
[Document subtitle]
[DATE]
[COMPANY NAME]
[Company address]
,1. Secondary Causes of Osteoporosis
• Common Drugs:
o Tamoxifen
o Steroids
o Proton Pump Inhibitors (PPIs)
• Other Causes:
o Hyperthyroidism
o Hyperparathyroidism
o Hypercalciuria
o Calcium/Vitamin D deficiency
o Rheumatoid Arthritis (RA)
o Celiac disease
o Malabsorptive diseases (e.g., Crohn's disease, ulcerative colitis)
2. Median Age of Menopause in U.S. Women
• Answer: 52.54 years
3. Premature Ovarian Insufficiency (POI)
• Definition: Intermittent ovarian function & insufficient estrogen levels occurring
at age <40 years.
4. STRAT stages related to reproductive life
• Menarche/Early Reproductive: -5
• Peak Reproductive: -4
• Late Reproductive: -3
• Perimenopause: -2 to -1 & +1a
• Final Menstrual Period (FMP) & 12 months after:
o FMP = 0,
o 12 months after = +1a
• Vasomotor Symptoms (VMS) most likely: +1a (most likely), -1 (likely)
• Early Postmenopause: +1a to +1c
, • Late Postmenopause: +2
• Amenorrhea >60 days: -1 (late menopause transition)
• Variable cycle lengths of >7 days differences: -2 (early menopause transition)
5. Differences between Menopause Transition vs Perimenopause (STRAT Criteria)
• Menopause Transition: -2 and -1, prior to FMP
• Perimenopause: -2 to +1a, includes 12 months of amenorrhea following FMP
6. Hormonal Markers
• Initial Drop in AMH/AFC/Inhibin, cycles still regular, FSH normal: -3b (late
reproductive)
• Cycles shorter, first increase in FSH: -3a (late reproductive)
• Levels spike with ovulation, marker of ovarian reserve: Inhibin B
• Most reflective of true ovarian reserve: AMH
7. Day of Cycle for FSH Draw
• Answer: Day 3
8. Normal Day 3 FSH Levels
• Normal: < 10
• Menopausal: > 25
9. Antral Follicle Count (AFC)
• Definition: # of ultrasound detected follicles 2-10 mm in size
• Normal AFC: >12
10. Luteal-Out-Of-Phase (LOOP) Event
• Description:
o FSH elevation recruits follicles for the subsequent cycle before the
current cycle concludes.
o Excess estradiol production as new follicles start growing increases the
chances of twins.
o Results in more time spent in luteal phase and more PMS/PMDD
symptoms.
11. Symptoms of LOOP Event
CERTIFICATION EXAM
ACTUAL EXAM COMPLETE
QUESTIONS WITH VERIFIED
ANSWERS 2025
[Document subtitle]
[DATE]
[COMPANY NAME]
[Company address]
,1. Secondary Causes of Osteoporosis
• Common Drugs:
o Tamoxifen
o Steroids
o Proton Pump Inhibitors (PPIs)
• Other Causes:
o Hyperthyroidism
o Hyperparathyroidism
o Hypercalciuria
o Calcium/Vitamin D deficiency
o Rheumatoid Arthritis (RA)
o Celiac disease
o Malabsorptive diseases (e.g., Crohn's disease, ulcerative colitis)
2. Median Age of Menopause in U.S. Women
• Answer: 52.54 years
3. Premature Ovarian Insufficiency (POI)
• Definition: Intermittent ovarian function & insufficient estrogen levels occurring
at age <40 years.
4. STRAT stages related to reproductive life
• Menarche/Early Reproductive: -5
• Peak Reproductive: -4
• Late Reproductive: -3
• Perimenopause: -2 to -1 & +1a
• Final Menstrual Period (FMP) & 12 months after:
o FMP = 0,
o 12 months after = +1a
• Vasomotor Symptoms (VMS) most likely: +1a (most likely), -1 (likely)
• Early Postmenopause: +1a to +1c
, • Late Postmenopause: +2
• Amenorrhea >60 days: -1 (late menopause transition)
• Variable cycle lengths of >7 days differences: -2 (early menopause transition)
5. Differences between Menopause Transition vs Perimenopause (STRAT Criteria)
• Menopause Transition: -2 and -1, prior to FMP
• Perimenopause: -2 to +1a, includes 12 months of amenorrhea following FMP
6. Hormonal Markers
• Initial Drop in AMH/AFC/Inhibin, cycles still regular, FSH normal: -3b (late
reproductive)
• Cycles shorter, first increase in FSH: -3a (late reproductive)
• Levels spike with ovulation, marker of ovarian reserve: Inhibin B
• Most reflective of true ovarian reserve: AMH
7. Day of Cycle for FSH Draw
• Answer: Day 3
8. Normal Day 3 FSH Levels
• Normal: < 10
• Menopausal: > 25
9. Antral Follicle Count (AFC)
• Definition: # of ultrasound detected follicles 2-10 mm in size
• Normal AFC: >12
10. Luteal-Out-Of-Phase (LOOP) Event
• Description:
o FSH elevation recruits follicles for the subsequent cycle before the
current cycle concludes.
o Excess estradiol production as new follicles start growing increases the
chances of twins.
o Results in more time spent in luteal phase and more PMS/PMDD
symptoms.
11. Symptoms of LOOP Event
