NAMs Menopause Certification Exam
Climacteric phase CORRECT ANSWER: The period of endrocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause CORRECT ANSWER: LMP before age 45
Late menopause CORRECT ANSWER: LMP after age 54
Primary ovarian insufficiency CORRECT ANSWER: Menopause that occurs before age 40
Early menopause transition (stage -2) CORRECT ANSWER: Persistent difference of 7 days or more in
the length of consecutive cycles.
Late menopause transition (stage -1) CORRECT ANSWER: 60 or more consecutive days of
amenorrhea
Luteal out of phase event (LOOP) CORRECT ANSWER: Explains why some perimenopausal women
have elevated estrogen level sometimes...In the early menopause transition, elevated FSH levels are
adequate to recruit a second follicle which results in a follicular phase-like rise in estradiol secretion
superimposed on the mid-to-late luteal phase of the ongoing ovulatory cycle.
Obese women and estradiol levels during menopause CORRECT ANSWER: Obese women are more
likely to have anovulatory cycles with high estradiol levels. They are also more likely to have lower
premenopause yet higher postmenopause estradiol levels compared with women of normal weight. (why
they are at higher risk of endometrial cancer)
Chinese and Japanese women CORRECT ANSWER: These ethnic groups have lower estradiol levels
then white, black and hispanic women.
stage +2 CORRECT ANSWER: late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c CORRECT ANSWER: early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
Elevated FSH, LH CORRECT ANSWER: Endocrine labs after menopause
AMH, inhibin B CORRECT ANSWER: These hormones work during reproductive years to not deplete
follicle pool too quickly.
Phases during menopause transition and PMS symptoms CORRECT ANSWER: Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? CORRECT ANSWER: many pitfalls, variable
depending on the day of the cycle you draw the lab, normal or low FSH is not helpful.
,The potentially superior marker of menopause, a lab. CORRECT ANSWER: AMH
DHEA (dehydroepiandrosterone) CORRECT ANSWER: Adrenal androgens: precursor hromones
produced by the adrenal gland that are enzymatically converted to active androgens or estrogens in
peripheral tissues.
Location of estrogen receptors CORRECT ANSWER: Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue CORRECT ANSWER: maintain blood flow, the collagen, and HA within
the epithelial surfaces. Supports microbiome which supports acidity of vagina and protects tissue from
pathogens.
Vaginal changes with menopause CORRECT ANSWER: Thinning, loss of elasticity, loss or absence or
rugae.
Vagina and urethra in menopause CORRECT ANSWER: vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence CORRECT ANSWER: Vaginal estrogen and urinary incontinence: what
type does it help with?
Treatment for FPHL CORRECT ANSWER: Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin?
CORRECT 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? and why? CORRECT
ANSWER: Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
AMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak? CORRECT ANSWER: 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.
AFC CORRECT ANSWER: 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.
, Late menopause transition (-1) FSH level on random draw CORRECT ANSWER: 25 or higher
Black women have higher or lower FSH levels? CORRECT ANSWER: Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic
women? CORRECT ANSWER: lower
Menopause transition-changes in SHBG and testosterone? ratio? CORRECT ANSWER: SHBG
decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what? CORRECT ANSWER: The free androgen index
What stage are VMS more likely? CORRECT ANSWER: +1b (generally last 2 years)
What hormone is generally higher in obese women? CORRECT ANSWER: Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones? CORRECT ANSWER:
testosterone and androstenedione
Surgical menopause causes women to have lower levels of what hormone? CORRECT ANSWER:
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?
CORRECT ANSWER: inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished follicle
pool.
In the menopause transition, women spend more time in what phase? CORRECT ANSWER: Luteal-
more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition CORRECT ANSWER: It is felt that the HPO axis may
become less sensitive to estrogen, so even with good follicle growth and estradiol secretion, LH surges
can fail which can lead to more cycle irregularity.
In the first year after the FMP, there is no production of what hormone? CORRECT ANSWER:
progesterone
What region of the adrenal gland secretes the androgens? CORRECT ANSWER: zona reticularis
what are considered the 'adrenal androgens'? CORRECT ANSWER: DHEA, DHEAS,
Androstenedione.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors.
CORRECT ANSWER: Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted
by the anterior pituitary.
Climacteric phase CORRECT ANSWER: The period of endrocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause CORRECT ANSWER: LMP before age 45
Late menopause CORRECT ANSWER: LMP after age 54
Primary ovarian insufficiency CORRECT ANSWER: Menopause that occurs before age 40
Early menopause transition (stage -2) CORRECT ANSWER: Persistent difference of 7 days or more in
the length of consecutive cycles.
Late menopause transition (stage -1) CORRECT ANSWER: 60 or more consecutive days of
amenorrhea
Luteal out of phase event (LOOP) CORRECT ANSWER: Explains why some perimenopausal women
have elevated estrogen level sometimes...In the early menopause transition, elevated FSH levels are
adequate to recruit a second follicle which results in a follicular phase-like rise in estradiol secretion
superimposed on the mid-to-late luteal phase of the ongoing ovulatory cycle.
Obese women and estradiol levels during menopause CORRECT ANSWER: Obese women are more
likely to have anovulatory cycles with high estradiol levels. They are also more likely to have lower
premenopause yet higher postmenopause estradiol levels compared with women of normal weight. (why
they are at higher risk of endometrial cancer)
Chinese and Japanese women CORRECT ANSWER: These ethnic groups have lower estradiol levels
then white, black and hispanic women.
stage +2 CORRECT ANSWER: late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c CORRECT ANSWER: early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
Elevated FSH, LH CORRECT ANSWER: Endocrine labs after menopause
AMH, inhibin B CORRECT ANSWER: These hormones work during reproductive years to not deplete
follicle pool too quickly.
Phases during menopause transition and PMS symptoms CORRECT ANSWER: Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? CORRECT ANSWER: many pitfalls, variable
depending on the day of the cycle you draw the lab, normal or low FSH is not helpful.
,The potentially superior marker of menopause, a lab. CORRECT ANSWER: AMH
DHEA (dehydroepiandrosterone) CORRECT ANSWER: Adrenal androgens: precursor hromones
produced by the adrenal gland that are enzymatically converted to active androgens or estrogens in
peripheral tissues.
Location of estrogen receptors CORRECT ANSWER: Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue CORRECT ANSWER: maintain blood flow, the collagen, and HA within
the epithelial surfaces. Supports microbiome which supports acidity of vagina and protects tissue from
pathogens.
Vaginal changes with menopause CORRECT ANSWER: Thinning, loss of elasticity, loss or absence or
rugae.
Vagina and urethra in menopause CORRECT ANSWER: vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence CORRECT ANSWER: Vaginal estrogen and urinary incontinence: what
type does it help with?
Treatment for FPHL CORRECT ANSWER: Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin?
CORRECT 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? and why? CORRECT
ANSWER: Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
AMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak? CORRECT ANSWER: 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.
AFC CORRECT ANSWER: 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.
, Late menopause transition (-1) FSH level on random draw CORRECT ANSWER: 25 or higher
Black women have higher or lower FSH levels? CORRECT ANSWER: Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic
women? CORRECT ANSWER: lower
Menopause transition-changes in SHBG and testosterone? ratio? CORRECT ANSWER: SHBG
decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what? CORRECT ANSWER: The free androgen index
What stage are VMS more likely? CORRECT ANSWER: +1b (generally last 2 years)
What hormone is generally higher in obese women? CORRECT ANSWER: Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones? CORRECT ANSWER:
testosterone and androstenedione
Surgical menopause causes women to have lower levels of what hormone? CORRECT ANSWER:
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?
CORRECT ANSWER: inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished follicle
pool.
In the menopause transition, women spend more time in what phase? CORRECT ANSWER: Luteal-
more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition CORRECT ANSWER: It is felt that the HPO axis may
become less sensitive to estrogen, so even with good follicle growth and estradiol secretion, LH surges
can fail which can lead to more cycle irregularity.
In the first year after the FMP, there is no production of what hormone? CORRECT ANSWER:
progesterone
What region of the adrenal gland secretes the androgens? CORRECT ANSWER: zona reticularis
what are considered the 'adrenal androgens'? CORRECT ANSWER: DHEA, DHEAS,
Androstenedione.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors.
CORRECT ANSWER: Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted
by the anterior pituitary.
