NAMS MENOPAUSE CERTIFICATION
EXAM QUESTIONS AND ANSWERS 100%
PASS 2026/2027
Climacteric phase - ANS The period of endocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
Early menopause - ANS LMP before age 45.
Late menopause - ANS LMP after age 54.
Primary ovarian insufficiency - ANS Menopause that occurs before age 40.
Early menopause transition (stage -2) - ANS Persistent difference of 7 days or more in the
length of consecutive cycles.
Late menopause transition (stage -1) - ANS 60 or more consecutive days of amenorrhea.
Luteal out of phase event (LOOP) - ANS Explains why some perimenopausal women have
elevated estrogen levels sometimes.
Obese women and estradiol levels during menopause - ANS Obese women are more likely to
have anovulatory cycles with high estradiol levels.
2026/2027 ALLRIGHTS RESERVED
1
,Chinese and Japanese women - ANS These ethnic groups have lower estradiol levels than
white, black, and Hispanic women.
Stage +2 - ANS Late menopause stage: 5-8 years after FMP. Somatic aging predominates.
Stages +1a, +1b, +1c - ANS Early post menopause: 2 years after FMP. FSH rises, estradiol
decreases.
Elevated FSH, LH - ANS Endocrine labs after menopause.
AMH, inhibin B - ANS These hormones work during reproductive years to not deplete follicle
pool too quickly.
Phases during menopause transition and PMS symptoms - ANS Menstrual cycle variable,
persistent >7 day difference between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? - ANS Many pitfalls, variable depending on the
day of the cycle you draw the lab.
The potentially superior marker of menopause, a lab. - ANS AMH.
DHEA (dehydroepiandrosterone) - ANS 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 - ANS Vagina, vulva, urethra, trigone of the bladder.
Effects of estrogen on tissue - ANS Maintain blood flow, the collagen, and HA within the
epithelial surfaces.
2026/2027 ALLRIGHTS RESERVED
2
,Vaginal changes with menopause - ANS Thinning, loss of elasticity, loss or absence of rugae.
Vagina and urethra in menopause - ANS Vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence - ANS Vaginal estrogen and urinary incontinence: what type does
it help with?
Treatment for FPHL - ANS Minoxidil, spironolactone, finasteride, estrogen therapy.
Late reproductive years -3b and -3a - ANS -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? - ANS Cycle day #3.
Elevated estradiol can suppress FSH giving a falsely normal FSH level.
AFC - ANS Antral follicle count. Number of follicles that are detectable with ultrasound.
Late menopause transition (-1) FSH level on random draw - ANS 25 or higher.
Black women have higher or lower FSH levels? - ANS Higher.
Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and Hispanic women? - ANS Lower.
Menopause transition-changes in SHBG and testosterone? - ANS SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
2026/2027 ALLRIGHTS RESERVED
3
, Testosterone/SHBG ratio is called what? - ANS The free androgen index.
What stage are VMS more likely? - ANS +1b (generally last 2 years).
What hormone is generally higher in obese women? - ANS Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones? - ANS Testosterone
and androstenedione.
Surgical menopause causes women to have lower levels of what hormone? -
ANS 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? - ANS Inhibin and AMH decrease.
In the menopause transition, women spend more time in what phase? - ANS Luteal-more
PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition - ANS It is felt that the HPO axis may become
less sensitive to estrogen.
In the first year after the FMP, there is no production of what hormone? - ANS Progesterone.
What region of the adrenal gland secretes the androgens? - ANS Zona reticularis.
What are considered the 'adrenal androgens'? - ANS DHEA, DHEAS, Androstenedione.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main
factors. - ANS Angiotensin II, potassium concentration, adrenocorticotropic hormone
secreted by the anterior pituitary.
2026/2027 ALLRIGHTS RESERVED
4
EXAM QUESTIONS AND ANSWERS 100%
PASS 2026/2027
Climacteric phase - ANS The period of endocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
Early menopause - ANS LMP before age 45.
Late menopause - ANS LMP after age 54.
Primary ovarian insufficiency - ANS Menopause that occurs before age 40.
Early menopause transition (stage -2) - ANS Persistent difference of 7 days or more in the
length of consecutive cycles.
Late menopause transition (stage -1) - ANS 60 or more consecutive days of amenorrhea.
Luteal out of phase event (LOOP) - ANS Explains why some perimenopausal women have
elevated estrogen levels sometimes.
Obese women and estradiol levels during menopause - ANS Obese women are more likely to
have anovulatory cycles with high estradiol levels.
2026/2027 ALLRIGHTS RESERVED
1
,Chinese and Japanese women - ANS These ethnic groups have lower estradiol levels than
white, black, and Hispanic women.
Stage +2 - ANS Late menopause stage: 5-8 years after FMP. Somatic aging predominates.
Stages +1a, +1b, +1c - ANS Early post menopause: 2 years after FMP. FSH rises, estradiol
decreases.
Elevated FSH, LH - ANS Endocrine labs after menopause.
AMH, inhibin B - ANS These hormones work during reproductive years to not deplete follicle
pool too quickly.
Phases during menopause transition and PMS symptoms - ANS Menstrual cycle variable,
persistent >7 day difference between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? - ANS Many pitfalls, variable depending on the
day of the cycle you draw the lab.
The potentially superior marker of menopause, a lab. - ANS AMH.
DHEA (dehydroepiandrosterone) - ANS 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 - ANS Vagina, vulva, urethra, trigone of the bladder.
Effects of estrogen on tissue - ANS Maintain blood flow, the collagen, and HA within the
epithelial surfaces.
2026/2027 ALLRIGHTS RESERVED
2
,Vaginal changes with menopause - ANS Thinning, loss of elasticity, loss or absence of rugae.
Vagina and urethra in menopause - ANS Vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence - ANS Vaginal estrogen and urinary incontinence: what type does
it help with?
Treatment for FPHL - ANS Minoxidil, spironolactone, finasteride, estrogen therapy.
Late reproductive years -3b and -3a - ANS -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? - ANS Cycle day #3.
Elevated estradiol can suppress FSH giving a falsely normal FSH level.
AFC - ANS Antral follicle count. Number of follicles that are detectable with ultrasound.
Late menopause transition (-1) FSH level on random draw - ANS 25 or higher.
Black women have higher or lower FSH levels? - ANS Higher.
Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and Hispanic women? - ANS Lower.
Menopause transition-changes in SHBG and testosterone? - ANS SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
2026/2027 ALLRIGHTS RESERVED
3
, Testosterone/SHBG ratio is called what? - ANS The free androgen index.
What stage are VMS more likely? - ANS +1b (generally last 2 years).
What hormone is generally higher in obese women? - ANS Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones? - ANS Testosterone
and androstenedione.
Surgical menopause causes women to have lower levels of what hormone? -
ANS 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? - ANS Inhibin and AMH decrease.
In the menopause transition, women spend more time in what phase? - ANS Luteal-more
PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition - ANS It is felt that the HPO axis may become
less sensitive to estrogen.
In the first year after the FMP, there is no production of what hormone? - ANS Progesterone.
What region of the adrenal gland secretes the androgens? - ANS Zona reticularis.
What are considered the 'adrenal androgens'? - ANS DHEA, DHEAS, Androstenedione.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main
factors. - ANS Angiotensin II, potassium concentration, adrenocorticotropic hormone
secreted by the anterior pituitary.
2026/2027 ALLRIGHTS RESERVED
4
