NAMS MENOPAUSE CERTIFICATION
EXAM QUESTIONS AND ANSWERS 2026
VERIFIED.
Climacteric phase - ANS The period of endrocrinologic, 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 level sometimes...In the early menopause transition, elevated FSH levels are
@2026/2027 ALLRIGHTS RESERVED.
,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 - ANS 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 - ANS These ethnic groups have lower estradiol levels then
white, black and hispanic women.
stage +2 - ANS late menopause stage: 5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.
Stages +1a, +1b, +1c - ANS early post menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
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 shortenes,
follicular phase compresses, women spend more time in luteal phase.. meaning more
premenstrual symptoms and more frequent menstrual periods.
How to respond if a patient requests FSH lab? - ANS many pitfalls, variable depending on the
day of the cycle you draw the lab, normal or low FSH is not helpful.
@2026/2027 ALLRIGHTS RESERVED.
, The potentially superior marker of menopause, a lab. - ANS AMH
DHEA (dehydroepiandrosterone) - ANS 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 - 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. Supports microbiome and protects tissue from pathogens.
Vaginal changes with menopause - ANS Thinning, loss of elasticity, loss or absence or 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 reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC,
inhibin? - 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.
@2026/2027 ALLRIGHTS RESERVED.
EXAM QUESTIONS AND ANSWERS 2026
VERIFIED.
Climacteric phase - ANS The period of endrocrinologic, 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 level sometimes...In the early menopause transition, elevated FSH levels are
@2026/2027 ALLRIGHTS RESERVED.
,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 - ANS 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 - ANS These ethnic groups have lower estradiol levels then
white, black and hispanic women.
stage +2 - ANS late menopause stage: 5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.
Stages +1a, +1b, +1c - ANS early post menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
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 shortenes,
follicular phase compresses, women spend more time in luteal phase.. meaning more
premenstrual symptoms and more frequent menstrual periods.
How to respond if a patient requests FSH lab? - ANS many pitfalls, variable depending on the
day of the cycle you draw the lab, normal or low FSH is not helpful.
@2026/2027 ALLRIGHTS RESERVED.
, The potentially superior marker of menopause, a lab. - ANS AMH
DHEA (dehydroepiandrosterone) - ANS 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 - 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. Supports microbiome and protects tissue from pathogens.
Vaginal changes with menopause - ANS Thinning, loss of elasticity, loss or absence or 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 reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC,
inhibin? - 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.
@2026/2027 ALLRIGHTS RESERVED.
