NAMS MENOPAUSE CERTIFICATION EXAM
STUDY SET ACTUAL EXAM COMPLETE 200
QUESTIONS WITH DETAILED VERIFIED
ANSWERS (100% CORRECT ANSWERS)
ALREADY GRADED A+
"premenopausal vs postmenopausal estradiol levels in obesity - CORRECT ANSWER=> pre: lower,
more anovulatory cycles
post: higher"
"consequence of inhibin B and AMH drop in early menopause transition? - CORRECT ANSWER=>
FSH spikes --> fast growth of remaining follicles (twins more likely) --> shorter follicular phase -->
follicle atresia --> LOOP cycles --> pronounced PMS sx from longer luteal phase --> cycle
irregularity by >7 days"
"dec ovarian reserve causes the drop in what 2 hormones? - CORRECT ANSWER=> inhibin B and
AMH"
"4 adrenal androgens - CORRECT ANSWER=> —Dehydroepiandrosterone (DHEA)
—Dehydroepiandrosterone sulfate (DHEAS)
—Androstenedione
—Testosterone"
"where are adrenal androgens converted to estrogen? - CORRECT ANSWER=> peripheral tissue"
"what happens to DHEA levels during menopause transition? - CORRECT ANSWER=> transient
increase then return to premenopause baseline"
"is DHEA supplementation in menopause recommended? - CORRECT ANSWER=> no
1|Pag e
,(Systematic review and meta-analysis of DHEA use in postmenopausal women with normal
adrenal function found no evidence of improvement in sexual symptoms, serum lipids, serum
glucose, weight, or bone mineral density)"
"dx of POI? - CORRECT ANSWER=> amenorrhea >4 mo in age <40
FSH >25 on 2 occasions"
"4 etiologies of POI
most common? - CORRECT ANSWER=> (1) Genetic (turner, fragile X)
(2) Autoimmune (adrenal Ab/Addison's)
(3) Cancer (chemo, radiation, surgical oophrectomy)
(4) Idiopathic --> most common"
"most common genetic cause of POI? - CORRECT ANSWER=> Turner syndrome/X chromosome
abnormalities"
"treatment for Turner syndrome with delayed puberty? - CORRECT ANSWER=> Started estrogen
replacement at age 12, add progestin at age of menarche
transdermal estradiol 0.1 mg recommended"
"diagnostic w/u for POI - CORRECT ANSWER=> FHx
Estradiol, FSH, LH
Karyotype
Anti-21hydroxylase antibodies --> Addison disease
Fragile X screen
TSH/T4/TPO
Glucose, metabolic profile, complete blood count"
"estrogen options for POI - CORRECT ANSWER=> 100 µg transdermal estradiol patch
1.25 mg conjugated equine estrogens (CEE)
2 mg of estradiol PO"
"progestin therapy for POI - CORRECT ANSWER=> If uterus is present, cyclical progestins should
be added ≥12 d/mo"
"estrogen maintains what pH in the vagina? - CORRECT ANSWER=> acidic, 3.8 - 4.5"
2|Pag e
, "high BMI associated with (increase/decrease) in severity of VMS in menopause transition -
CORRECT ANSWER=> increase"
"% skin collagen loss in 1st 5 yrs after menopause - CORRECT ANSWER=> 30%
(2% per yr decline over next 20 yrs)"
"2 most common causes of hair loss in menopause transition - CORRECT ANSWER=> Female
pattern hair loss (FPHL; thinning on crown) and telogen effluvium (sudden onset of hair
shedding, stress-induced)"
"tx of FPHL - CORRECT ANSWER=> topical minoxidil (FDA-approved)
spiro/finasteride (off label)"
"median duration of VMS - CORRECT ANSWER=> 7-10 yrs"
"ethnic group with most VMS?
ethnic group with least VMS? - CORRECT ANSWER=> black
japanese"
"RFs for VMS - CORRECT ANSWER=> •Low socioeconomic status
•Low educational attainment
•Obesity (only in perimenopause)
•Tobacco/Nicotine use
•Hysterectomy/Oophorectomy"
"Mechanism of hot flashes (KNDy neurons) / how fezolinetant works - CORRECT ANSWER=>
Hypothalamus KNDy neuron = thermoregulatory center
Estrogen = "the breaks," inhibits KNDy neuron, dec temp --> loss of estrogen = loss of breaks, inc
temp
NKB = "the gas," excited KNDy neuron, inc temp --> loss of estrogen = unchecked stimulation
Fezolinetant = NKB antagonist"
3|Pag e
STUDY SET ACTUAL EXAM COMPLETE 200
QUESTIONS WITH DETAILED VERIFIED
ANSWERS (100% CORRECT ANSWERS)
ALREADY GRADED A+
"premenopausal vs postmenopausal estradiol levels in obesity - CORRECT ANSWER=> pre: lower,
more anovulatory cycles
post: higher"
"consequence of inhibin B and AMH drop in early menopause transition? - CORRECT ANSWER=>
FSH spikes --> fast growth of remaining follicles (twins more likely) --> shorter follicular phase -->
follicle atresia --> LOOP cycles --> pronounced PMS sx from longer luteal phase --> cycle
irregularity by >7 days"
"dec ovarian reserve causes the drop in what 2 hormones? - CORRECT ANSWER=> inhibin B and
AMH"
"4 adrenal androgens - CORRECT ANSWER=> —Dehydroepiandrosterone (DHEA)
—Dehydroepiandrosterone sulfate (DHEAS)
—Androstenedione
—Testosterone"
"where are adrenal androgens converted to estrogen? - CORRECT ANSWER=> peripheral tissue"
"what happens to DHEA levels during menopause transition? - CORRECT ANSWER=> transient
increase then return to premenopause baseline"
"is DHEA supplementation in menopause recommended? - CORRECT ANSWER=> no
1|Pag e
,(Systematic review and meta-analysis of DHEA use in postmenopausal women with normal
adrenal function found no evidence of improvement in sexual symptoms, serum lipids, serum
glucose, weight, or bone mineral density)"
"dx of POI? - CORRECT ANSWER=> amenorrhea >4 mo in age <40
FSH >25 on 2 occasions"
"4 etiologies of POI
most common? - CORRECT ANSWER=> (1) Genetic (turner, fragile X)
(2) Autoimmune (adrenal Ab/Addison's)
(3) Cancer (chemo, radiation, surgical oophrectomy)
(4) Idiopathic --> most common"
"most common genetic cause of POI? - CORRECT ANSWER=> Turner syndrome/X chromosome
abnormalities"
"treatment for Turner syndrome with delayed puberty? - CORRECT ANSWER=> Started estrogen
replacement at age 12, add progestin at age of menarche
transdermal estradiol 0.1 mg recommended"
"diagnostic w/u for POI - CORRECT ANSWER=> FHx
Estradiol, FSH, LH
Karyotype
Anti-21hydroxylase antibodies --> Addison disease
Fragile X screen
TSH/T4/TPO
Glucose, metabolic profile, complete blood count"
"estrogen options for POI - CORRECT ANSWER=> 100 µg transdermal estradiol patch
1.25 mg conjugated equine estrogens (CEE)
2 mg of estradiol PO"
"progestin therapy for POI - CORRECT ANSWER=> If uterus is present, cyclical progestins should
be added ≥12 d/mo"
"estrogen maintains what pH in the vagina? - CORRECT ANSWER=> acidic, 3.8 - 4.5"
2|Pag e
, "high BMI associated with (increase/decrease) in severity of VMS in menopause transition -
CORRECT ANSWER=> increase"
"% skin collagen loss in 1st 5 yrs after menopause - CORRECT ANSWER=> 30%
(2% per yr decline over next 20 yrs)"
"2 most common causes of hair loss in menopause transition - CORRECT ANSWER=> Female
pattern hair loss (FPHL; thinning on crown) and telogen effluvium (sudden onset of hair
shedding, stress-induced)"
"tx of FPHL - CORRECT ANSWER=> topical minoxidil (FDA-approved)
spiro/finasteride (off label)"
"median duration of VMS - CORRECT ANSWER=> 7-10 yrs"
"ethnic group with most VMS?
ethnic group with least VMS? - CORRECT ANSWER=> black
japanese"
"RFs for VMS - CORRECT ANSWER=> •Low socioeconomic status
•Low educational attainment
•Obesity (only in perimenopause)
•Tobacco/Nicotine use
•Hysterectomy/Oophorectomy"
"Mechanism of hot flashes (KNDy neurons) / how fezolinetant works - CORRECT ANSWER=>
Hypothalamus KNDy neuron = thermoregulatory center
Estrogen = "the breaks," inhibits KNDy neuron, dec temp --> loss of estrogen = loss of breaks, inc
temp
NKB = "the gas," excited KNDy neuron, inc temp --> loss of estrogen = unchecked stimulation
Fezolinetant = NKB antagonist"
3|Pag e
