NAMS Menopause Certification Exam 2024-2025
Practice Guide
1. Climacteric phase The period of endrocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
2. Perimenopause STRAW Stage: (Stage -2)
Menopause Transition, Persistent ditterence of 7 days or more in the length of consecutive
Early cycles.
List the STRAW Stage
What defines the phase?
3. Perimenopause STRAW Stage: (Stage -1)
Menopause Transition, 60 or more consecutive days of amenorrhea
Late
List the STRAW Stage
What defines the phase?
4. Luteal out of phase Explains why some perimenopausal women have elevated estrogen
event (LOOP) level sometimes...In the early menopause transition, elevated FSH lev-
els 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.
5. Describe the E2 level They are also more likely to have lower premenopause/peri-
during the life of a pa- menopausal estradiol levels compared to patients with average BMIs.
tient with obesity. However, the level is the highest in postmenopausal patients with
obesity.
6. In comparison to other These ethnic groups have lower estradiol levels than white, black and
ethnicities, Chinese and hispanic women.
Japanese women have
E2 levels?
7. STRAW Stage +2, de- Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP. So-
scribe the timeline as matic aging predominates. Increased genitourinary symptoms.
, NAMS Menopause Certification Exam 2024-2025
Practice Guide
well as the predominant
symptoms.
8. Stages +1a, +1b, +1c, de- Postmenopause, Early. 2 years after FMP.
scribe the timeline as +1a/b (2yrs) FSH variable where as the AMH and InhB are low. The AFC
well as the supportive are very low. VMS predominate.
criteria and the symp- 1c (3-6yrs) FSH levels stabilize. The other measures continue as previ-
toms. ous.
9. Elevated FSH, LH Endocrine labs after menopause
10. AMH, Inhibin B These hormones work during reproductive years to not deplete follicle
pool too quickly.
11. Describe the phases dur- Menstrual cycle shortens. Due to unrestrained FSH, follicular phase
ing the early menopause compresses. More premenstrual symptoms due to the longer luteal
transition and what hap- phase. Cycle irregularity and skipped cycles because of ovulatory fail-
pens with PMS symp- ure and increased atresia.
toms
12. How to respond if a pa- many pitfalls, variable depending on the day of the cycle you draw the
tient requests FSH lab? lab, normal or low FSH is not helpful.
13. What lab is potentially AMH
the superior marker of
time to menopause?
14. DHEA (dehy- Adrenal androgens: precursor hromones produced by the adrenal
droepiandrosterone) gland that are enzymatically converted to active androgens or estro-
gens in peripheral tissues.
15. Location of GU estrogen Vagina, vulva, urethra, trigone of the bladder
receptors (4)
, NAMS Menopause Certification Exam 2024-2025
Practice Guide
16. List the effects of estro- 1 ) maintains blood flow to tissue, maintains the collagen within the
gen on tissue (4+2) epithelium, and maintains the hyaluronic acid and mucopolysaccha-
rides within the moistened epithelial surface, maintains pH (4.5) 2)
supports microbiome and protects tissue from pathogens
17. List the vaginal changes Thinning of the epithelial layer, loss of elasticity with narrowing of the
with menopause you canal and poor distention, noted on pelvic exam with loss or absence
might note on clini- or rugae. Due to the decrease in glycogen content, the lactobacilli are
cal/microscopic exam. decreased resulting in higher pH.
18. List the vulvar and Thinning of the epithelial layers and vagina narrowing leads the ure-
urethral changes in thra to move closer to the introitus.
menopause.
19. Stress urinary inconti- Vaginal estrogen and urinary incontinence: what type does it help with?
nence
20. Treatment for FPHL Minoxidil, spironolactone, finasteride, estrogen therapy
21. Late reporoductive years -3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin
-3b and -3a. What hap- low.
pens with menstrual cy-
cles, FSH, AMH, AFC, in- -3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin
hibin? low.
22. When it is appropriate to Cycle day #3. Elevated estradiol can suppress FSH giving a falsely
check an FSH during the normal FSH level.
cycle if you check it? and
why?
23. AMH produced by granulosa cells
produced by...
used to test... used to test damage to ovarian follicle reserve. If AMH is low, the
woman has a low ovarian reserve.
, NAMS Menopause Certification Exam 2024-2025
Practice Guide
Is it a screening tool for
fertility? not recommended as a screening tool to predict fertility.
When does it peak?
Peaks at around 25 years old. So before age 25, this test is not helpful.
It is influenced by exogenous hormones. Lower in hormonal contra-
ception users, but increases after d/cing.
24. What does AFC stand Antral Follicle Count
for? What is considered a > 12 follicles detectable with ultrasound is considered normal
normal value?
25. What is the significance The ability of the ovaries to respond. It can represent the number of
of antral follicle count? follicles detectable with ultrasound. It is sensitive to FSH, and repre-
sents the available pool of follicles.
26. What is the FSH level 25 IU/L or higher
on a random draw in
Late menopause transi-
tion (STRAW Stage: -1)?
27. Black women have high- Higher
er or lower FSH levels?
28. Chinese and Japan- Lower
ese women have high-
er or lower estradi-
ol levels compared to
white, black and hispan-
ic women?
29. What happens to SHBG SHBG decreases.
during menopause? Testosterone/SHBG ratio increases by 80%.
Practice Guide
1. Climacteric phase The period of endrocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
2. Perimenopause STRAW Stage: (Stage -2)
Menopause Transition, Persistent ditterence of 7 days or more in the length of consecutive
Early cycles.
List the STRAW Stage
What defines the phase?
3. Perimenopause STRAW Stage: (Stage -1)
Menopause Transition, 60 or more consecutive days of amenorrhea
Late
List the STRAW Stage
What defines the phase?
4. Luteal out of phase Explains why some perimenopausal women have elevated estrogen
event (LOOP) level sometimes...In the early menopause transition, elevated FSH lev-
els 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.
5. Describe the E2 level They are also more likely to have lower premenopause/peri-
during the life of a pa- menopausal estradiol levels compared to patients with average BMIs.
tient with obesity. However, the level is the highest in postmenopausal patients with
obesity.
6. In comparison to other These ethnic groups have lower estradiol levels than white, black and
ethnicities, Chinese and hispanic women.
Japanese women have
E2 levels?
7. STRAW Stage +2, de- Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP. So-
scribe the timeline as matic aging predominates. Increased genitourinary symptoms.
, NAMS Menopause Certification Exam 2024-2025
Practice Guide
well as the predominant
symptoms.
8. Stages +1a, +1b, +1c, de- Postmenopause, Early. 2 years after FMP.
scribe the timeline as +1a/b (2yrs) FSH variable where as the AMH and InhB are low. The AFC
well as the supportive are very low. VMS predominate.
criteria and the symp- 1c (3-6yrs) FSH levels stabilize. The other measures continue as previ-
toms. ous.
9. Elevated FSH, LH Endocrine labs after menopause
10. AMH, Inhibin B These hormones work during reproductive years to not deplete follicle
pool too quickly.
11. Describe the phases dur- Menstrual cycle shortens. Due to unrestrained FSH, follicular phase
ing the early menopause compresses. More premenstrual symptoms due to the longer luteal
transition and what hap- phase. Cycle irregularity and skipped cycles because of ovulatory fail-
pens with PMS symp- ure and increased atresia.
toms
12. How to respond if a pa- many pitfalls, variable depending on the day of the cycle you draw the
tient requests FSH lab? lab, normal or low FSH is not helpful.
13. What lab is potentially AMH
the superior marker of
time to menopause?
14. DHEA (dehy- Adrenal androgens: precursor hromones produced by the adrenal
droepiandrosterone) gland that are enzymatically converted to active androgens or estro-
gens in peripheral tissues.
15. Location of GU estrogen Vagina, vulva, urethra, trigone of the bladder
receptors (4)
, NAMS Menopause Certification Exam 2024-2025
Practice Guide
16. List the effects of estro- 1 ) maintains blood flow to tissue, maintains the collagen within the
gen on tissue (4+2) epithelium, and maintains the hyaluronic acid and mucopolysaccha-
rides within the moistened epithelial surface, maintains pH (4.5) 2)
supports microbiome and protects tissue from pathogens
17. List the vaginal changes Thinning of the epithelial layer, loss of elasticity with narrowing of the
with menopause you canal and poor distention, noted on pelvic exam with loss or absence
might note on clini- or rugae. Due to the decrease in glycogen content, the lactobacilli are
cal/microscopic exam. decreased resulting in higher pH.
18. List the vulvar and Thinning of the epithelial layers and vagina narrowing leads the ure-
urethral changes in thra to move closer to the introitus.
menopause.
19. Stress urinary inconti- Vaginal estrogen and urinary incontinence: what type does it help with?
nence
20. Treatment for FPHL Minoxidil, spironolactone, finasteride, estrogen therapy
21. Late reporoductive years -3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin
-3b and -3a. What hap- low.
pens with menstrual cy-
cles, FSH, AMH, AFC, in- -3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin
hibin? low.
22. When it is appropriate to Cycle day #3. Elevated estradiol can suppress FSH giving a falsely
check an FSH during the normal FSH level.
cycle if you check it? and
why?
23. AMH produced by granulosa cells
produced by...
used to test... used to test damage to ovarian follicle reserve. If AMH is low, the
woman has a low ovarian reserve.
, NAMS Menopause Certification Exam 2024-2025
Practice Guide
Is it a screening tool for
fertility? not recommended as a screening tool to predict fertility.
When does it peak?
Peaks at around 25 years old. So before age 25, this test is not helpful.
It is influenced by exogenous hormones. Lower in hormonal contra-
ception users, but increases after d/cing.
24. What does AFC stand Antral Follicle Count
for? What is considered a > 12 follicles detectable with ultrasound is considered normal
normal value?
25. What is the significance The ability of the ovaries to respond. It can represent the number of
of antral follicle count? follicles detectable with ultrasound. It is sensitive to FSH, and repre-
sents the available pool of follicles.
26. What is the FSH level 25 IU/L or higher
on a random draw in
Late menopause transi-
tion (STRAW Stage: -1)?
27. Black women have high- Higher
er or lower FSH levels?
28. Chinese and Japan- Lower
ese women have high-
er or lower estradi-
ol levels compared to
white, black and hispan-
ic women?
29. What happens to SHBG SHBG decreases.
during menopause? Testosterone/SHBG ratio increases by 80%.
