NAMS MENOPAUSE CERTIFICATION UPDATED
ACTUAL EXAM QUESTIONS AND CORRECT
ANSWERS FULL SOLUTION GRADED A+
◉ Early menopause. Answer: LMP before age 45.
◉ Late menopause. Answer: LMP after age 54.
◉ Primary ovarian insufficiency. Answer: Menopause that occurs
before age 40.
◉ Early menopause transition (stage -2). Answer: Persistent
difference of 7 days or more in the length of consecutive cycles.
◉ Late menopause transition (stage -1). Answer: 60 or more
consecutive days of amenorrhea.
◉ Luteal out of phase event (LOOP). Answer: Explains why some
perimenopausal women have elevated estrogen levels sometimes.
◉ Obese women and estradiol levels during menopause. Answer:
Obese women are more likely to have anovulatory cycles with high
estradiol levels.
,◉ Chinese and Japanese women. Answer: These ethnic groups have
lower estradiol levels than white, black, and Hispanic women.
◉ Stage +2. Answer: Late menopause stage: 5-8 years after FMP.
Somatic aging predominates.
◉ Stages +1a, +1b, +1c. Answer: Early post menopause: 2 years after
FMP. FSH rises, estradiol decreases.
◉ Elevated FSH, LH. Answer: Endocrine labs after menopause.
◉ AMH, inhibin B. Answer: These hormones work during
reproductive years to not deplete follicle pool too quickly.
◉ Phases during menopause transition and PMS symptoms. Answer:
Menstrual cycle variable, persistent >7 day difference between
difference in length of consecutive cycles.
◉ How to respond if a patient requests FSH lab?. Answer: Many
pitfalls, variable depending on the day of the cycle you draw the lab.
◉ The potentially superior marker of menopause, a lab.. Answer:
AMH.
◉ DHEA (dehydroepiandrosterone). Answer: 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. Answer: Vagina, vulva, urethra,
trigone of the bladder.
◉ Effects of estrogen on tissue. Answer: Maintain blood flow, the
collagen, and HA within the epithelial surfaces.
◉ Vaginal changes with menopause. Answer: Thinning, loss of
elasticity, loss or absence of rugae.
◉ Vagina and urethra in menopause. Answer: Vagina narrows, urethra
moves closer to the introitus.
◉ Stress urinary incontinence. Answer: Vaginal estrogen and urinary
incontinence: what type does it help with?
◉ Treatment for FPHL. Answer: Minoxidil, spironolactone,
finasteride, estrogen therapy.
◉ Late reproductive years -3b and -3a. 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?. Answer: Cycle day #3. Elevated estradiol can suppress FSH
giving a falsely normal FSH level.
◉ AFC. Answer: Antral follicle count. Number of follicles that are
detectable with ultrasound.
◉ Late menopause transition (-1) FSH level on random draw.
Answer: 25 or higher.
◉ Black women have higher or lower FSH levels?. Answer: Higher.
◉ Chinese and Japanese women have higher or lower estradiol levels
compared to white, black and Hispanic women?. Answer: Lower.
◉ Menopause transition-changes in SHBG and testosterone?.
Answer: SHBG decreases. Testosterone/SHBG ratio increases by
80%.
◉ Testosterone/SHBG ratio is called what?. Answer: The free
androgen index.
◉ What stage are VMS more likely?. Answer: +1b (generally last 2
years).
ACTUAL EXAM QUESTIONS AND CORRECT
ANSWERS FULL SOLUTION GRADED A+
◉ Early menopause. Answer: LMP before age 45.
◉ Late menopause. Answer: LMP after age 54.
◉ Primary ovarian insufficiency. Answer: Menopause that occurs
before age 40.
◉ Early menopause transition (stage -2). Answer: Persistent
difference of 7 days or more in the length of consecutive cycles.
◉ Late menopause transition (stage -1). Answer: 60 or more
consecutive days of amenorrhea.
◉ Luteal out of phase event (LOOP). Answer: Explains why some
perimenopausal women have elevated estrogen levels sometimes.
◉ Obese women and estradiol levels during menopause. Answer:
Obese women are more likely to have anovulatory cycles with high
estradiol levels.
,◉ Chinese and Japanese women. Answer: These ethnic groups have
lower estradiol levels than white, black, and Hispanic women.
◉ Stage +2. Answer: Late menopause stage: 5-8 years after FMP.
Somatic aging predominates.
◉ Stages +1a, +1b, +1c. Answer: Early post menopause: 2 years after
FMP. FSH rises, estradiol decreases.
◉ Elevated FSH, LH. Answer: Endocrine labs after menopause.
◉ AMH, inhibin B. Answer: These hormones work during
reproductive years to not deplete follicle pool too quickly.
◉ Phases during menopause transition and PMS symptoms. Answer:
Menstrual cycle variable, persistent >7 day difference between
difference in length of consecutive cycles.
◉ How to respond if a patient requests FSH lab?. Answer: Many
pitfalls, variable depending on the day of the cycle you draw the lab.
◉ The potentially superior marker of menopause, a lab.. Answer:
AMH.
◉ DHEA (dehydroepiandrosterone). Answer: 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. Answer: Vagina, vulva, urethra,
trigone of the bladder.
◉ Effects of estrogen on tissue. Answer: Maintain blood flow, the
collagen, and HA within the epithelial surfaces.
◉ Vaginal changes with menopause. Answer: Thinning, loss of
elasticity, loss or absence of rugae.
◉ Vagina and urethra in menopause. Answer: Vagina narrows, urethra
moves closer to the introitus.
◉ Stress urinary incontinence. Answer: Vaginal estrogen and urinary
incontinence: what type does it help with?
◉ Treatment for FPHL. Answer: Minoxidil, spironolactone,
finasteride, estrogen therapy.
◉ Late reproductive years -3b and -3a. 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?. Answer: Cycle day #3. Elevated estradiol can suppress FSH
giving a falsely normal FSH level.
◉ AFC. Answer: Antral follicle count. Number of follicles that are
detectable with ultrasound.
◉ Late menopause transition (-1) FSH level on random draw.
Answer: 25 or higher.
◉ Black women have higher or lower FSH levels?. Answer: Higher.
◉ Chinese and Japanese women have higher or lower estradiol levels
compared to white, black and Hispanic women?. Answer: Lower.
◉ Menopause transition-changes in SHBG and testosterone?.
Answer: SHBG decreases. Testosterone/SHBG ratio increases by
80%.
◉ Testosterone/SHBG ratio is called what?. Answer: The free
androgen index.
◉ What stage are VMS more likely?. Answer: +1b (generally last 2
years).
