NAMS Menopause Certification Exam 2026
Study Guide
1. secondary causes Hyperthyroidism, hyperparathyroidism, hypercalciuria, certain drugs (eg: ta-
of osteoporosis moxifen, steroids, PPIs), calcium/vitamin D deficiency, RA, celiac disease, mal-
absorptive diseases such as Crohn disease, and ulcerative colitis
which 3 common
drugs?
2. Median age of 52.54 y
menopause in US
women
3. POI Intermittent ovarian function & insuflcient estrogen levels occurring at age <40
y
4. which STRAW -5
stage?
menarche / early
reproductive
5. which STRAW -4
stage?
peak reproductive
6. which STRAW -3
stage?
late reproductive
7. which STRAW -2 to -1 & +1a
stage?
perimenopause
, NAMS Menopause Certification Exam 2026
Study Guide
8. which STRAW FMP = 0
stage? 12 months after = +1a
FMP &
12 months after fi-
nal menstrual peri-
od
9. which STRAW +1a (most likely)
stage? -1 (likely)
VMS most likely aka perimenopause/menopause transition
10. which STRAW +1a to +1c
stage?
early post
menopause
11. which STRAW +2
stage?
late post-
menopause
12. which STRAW -1
stage?
aka late menopause transition
amenorrhea >60
days
13. which STRAW -2
stage?
aka early menopause transition
, NAMS Menopause Certification Exam 2026
Study Guide
variable cycle
lengths of >7 days
differences
14. difference between menopause transition: -2 and -1, prior to FMP
menopause tran-
sition vs per- perimenopause: -2 to +1a, includes 12 mo of amenorrhea following FMP
imenopause per
STRAW criteria?
15. which STRAW -3b
stage?
aka late reproductive
initial drop
in AMH/AFC/inhib-
in, cycles still regu-
lar, FSH normal
16. which STRAW -3a
stage?
aka late reproductive
cycles shorter, first
increase in FSH
17. levels spike with inhibin B
ovulation, marker
of ovarian reserve
18. Produced by gran- AMH
ulosa cells of
activated follicles,
most reflective of
true ovarian re-
, NAMS Menopause Certification Exam 2026
Study Guide
serve; provides the
best single predic-
tion of time to
menopause
19. what day of cy- day 3
cle to draw FSH to
predict ovarian re-
sponse/reserve?
20. normal day 3 FSH? < 10
FSH value for >25
menopause?
21. # of ultrasound de- AFC (antral follicle count)
tected follicles 2-10
mm in size
22. normal AFC >12
23. Luteal-Out-Of-Phase- FSH elevation recruits follicles for the subsequent cycle before the current
(LOOP) event cycle is over
- Excess estradiol production as new follicles start growing
- Increase chance of TWINS
- Very short follicular phase
- More time spent in luteal phase (more PMS/PMDD sx)
24. symptoms of LOOP —Mastalgia
event —Worsening migraine
—Growing fibroids
—Risk of endometrial hyperplasia
- longer time in luteal phase (worsening PMDD in peri)
Study Guide
1. secondary causes Hyperthyroidism, hyperparathyroidism, hypercalciuria, certain drugs (eg: ta-
of osteoporosis moxifen, steroids, PPIs), calcium/vitamin D deficiency, RA, celiac disease, mal-
absorptive diseases such as Crohn disease, and ulcerative colitis
which 3 common
drugs?
2. Median age of 52.54 y
menopause in US
women
3. POI Intermittent ovarian function & insuflcient estrogen levels occurring at age <40
y
4. which STRAW -5
stage?
menarche / early
reproductive
5. which STRAW -4
stage?
peak reproductive
6. which STRAW -3
stage?
late reproductive
7. which STRAW -2 to -1 & +1a
stage?
perimenopause
, NAMS Menopause Certification Exam 2026
Study Guide
8. which STRAW FMP = 0
stage? 12 months after = +1a
FMP &
12 months after fi-
nal menstrual peri-
od
9. which STRAW +1a (most likely)
stage? -1 (likely)
VMS most likely aka perimenopause/menopause transition
10. which STRAW +1a to +1c
stage?
early post
menopause
11. which STRAW +2
stage?
late post-
menopause
12. which STRAW -1
stage?
aka late menopause transition
amenorrhea >60
days
13. which STRAW -2
stage?
aka early menopause transition
, NAMS Menopause Certification Exam 2026
Study Guide
variable cycle
lengths of >7 days
differences
14. difference between menopause transition: -2 and -1, prior to FMP
menopause tran-
sition vs per- perimenopause: -2 to +1a, includes 12 mo of amenorrhea following FMP
imenopause per
STRAW criteria?
15. which STRAW -3b
stage?
aka late reproductive
initial drop
in AMH/AFC/inhib-
in, cycles still regu-
lar, FSH normal
16. which STRAW -3a
stage?
aka late reproductive
cycles shorter, first
increase in FSH
17. levels spike with inhibin B
ovulation, marker
of ovarian reserve
18. Produced by gran- AMH
ulosa cells of
activated follicles,
most reflective of
true ovarian re-
, NAMS Menopause Certification Exam 2026
Study Guide
serve; provides the
best single predic-
tion of time to
menopause
19. what day of cy- day 3
cle to draw FSH to
predict ovarian re-
sponse/reserve?
20. normal day 3 FSH? < 10
FSH value for >25
menopause?
21. # of ultrasound de- AFC (antral follicle count)
tected follicles 2-10
mm in size
22. normal AFC >12
23. Luteal-Out-Of-Phase- FSH elevation recruits follicles for the subsequent cycle before the current
(LOOP) event cycle is over
- Excess estradiol production as new follicles start growing
- Increase chance of TWINS
- Very short follicular phase
- More time spent in luteal phase (more PMS/PMDD sx)
24. symptoms of LOOP —Mastalgia
event —Worsening migraine
—Growing fibroids
—Risk of endometrial hyperplasia
- longer time in luteal phase (worsening PMDD in peri)
