NAMS CERTIFICATION LATEST 2026 STUDY GUIDE
QUESTIONS AND ANSWERS GRADED A+
✔✔AFC - ✔✔Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability poo of follicles.
✔✔Late menopause transition (-1) FSH level on random draw - ✔✔25 or higher
✔✔Black women have higher or lower FSH levels? - ✔✔Higher
✔✔Chinese and Japanese women have higher or lower estradiol levels compared to
white, black and hispanic women? - ✔✔lower
✔✔Menopause transition-changes in SHBG and testosterone? ratio? - ✔✔SHBG
decreases
Testosterone/SHBG ratio increases by 80%.
✔✔Testosterone/SHGB ratio is called what? - ✔✔The free androgen index
✔✔What stage are VMS more likely? - ✔✔+1b (generally last 2 years)
✔✔What hormone is generally higher in obese women? - ✔✔Estrone-via aromatization.
✔✔The postmenopausal ovary continues to produce what two hormones? -
✔✔testosterone and androstenedione
✔✔Surgical menopause causes women to have lower levels of what hormone? -
✔✔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? - ✔✔inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining,
diminished follicle pool.
✔✔In the menopause transition, women spend more time in what phase? - ✔✔Luteal-
more PMS symptoms, more frequent menstrual periods.
✔✔HPO axis theory and the menopause transition - ✔✔It is felt that the HPO axis may
become less sensitive to estrogen, so even with good follicle growth and estradiol
secretion, LH surges can fail which can lead to more cycle irregularity.
, ✔✔In the first year after the FMP, there is no production of what hormone? -
✔✔progesterone
✔✔What region of the adrenal gland secretes the androgens? - ✔✔zona reticularis
✔✔what are considered the 'adrenal androgens'? - ✔✔DHEA, DHEAS,
Androstenedione.
✔✔Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3
main factors. - ✔✔Angiotensin II, potassium concentration, adrenocorticotropic hormone
secreted by the anterior pituitary.
✔✔What part of the pituitary gland secretes adrenocorticotropic hormone? - ✔✔Anterior
pituitary. The posterior only secretes vasopressin and oxytosin.
✔✔Cortisol and HRT - ✔✔Most serum cortisol circulates bound to cortisol binding
globulin.
Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol
concentration.
✔✔Do cortisol levels associate with VMS severity? - ✔✔No, cortisol levels have NOT
been associated with more severe VMS.
✔✔Local DHEA has been proven to help with what? - ✔✔vaginal pain and dyspareunia
✔✔How to DX POI? - ✔✔Menstrual disturbance-oligomenorrhea or amenorrhea for at
least 4 months.
AND
elevated FSH over 25 on two occasions at least 4 weeks apart.
✔✔Anyone <40years old who misses 3+ consecutive cycles gets these labs -
✔✔prolactin
FSH
estradiol
TSH
pregnancy test
QUESTIONS AND ANSWERS GRADED A+
✔✔AFC - ✔✔Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability poo of follicles.
✔✔Late menopause transition (-1) FSH level on random draw - ✔✔25 or higher
✔✔Black women have higher or lower FSH levels? - ✔✔Higher
✔✔Chinese and Japanese women have higher or lower estradiol levels compared to
white, black and hispanic women? - ✔✔lower
✔✔Menopause transition-changes in SHBG and testosterone? ratio? - ✔✔SHBG
decreases
Testosterone/SHBG ratio increases by 80%.
✔✔Testosterone/SHGB ratio is called what? - ✔✔The free androgen index
✔✔What stage are VMS more likely? - ✔✔+1b (generally last 2 years)
✔✔What hormone is generally higher in obese women? - ✔✔Estrone-via aromatization.
✔✔The postmenopausal ovary continues to produce what two hormones? -
✔✔testosterone and androstenedione
✔✔Surgical menopause causes women to have lower levels of what hormone? -
✔✔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? - ✔✔inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining,
diminished follicle pool.
✔✔In the menopause transition, women spend more time in what phase? - ✔✔Luteal-
more PMS symptoms, more frequent menstrual periods.
✔✔HPO axis theory and the menopause transition - ✔✔It is felt that the HPO axis may
become less sensitive to estrogen, so even with good follicle growth and estradiol
secretion, LH surges can fail which can lead to more cycle irregularity.
, ✔✔In the first year after the FMP, there is no production of what hormone? -
✔✔progesterone
✔✔What region of the adrenal gland secretes the androgens? - ✔✔zona reticularis
✔✔what are considered the 'adrenal androgens'? - ✔✔DHEA, DHEAS,
Androstenedione.
✔✔Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3
main factors. - ✔✔Angiotensin II, potassium concentration, adrenocorticotropic hormone
secreted by the anterior pituitary.
✔✔What part of the pituitary gland secretes adrenocorticotropic hormone? - ✔✔Anterior
pituitary. The posterior only secretes vasopressin and oxytosin.
✔✔Cortisol and HRT - ✔✔Most serum cortisol circulates bound to cortisol binding
globulin.
Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol
concentration.
✔✔Do cortisol levels associate with VMS severity? - ✔✔No, cortisol levels have NOT
been associated with more severe VMS.
✔✔Local DHEA has been proven to help with what? - ✔✔vaginal pain and dyspareunia
✔✔How to DX POI? - ✔✔Menstrual disturbance-oligomenorrhea or amenorrhea for at
least 4 months.
AND
elevated FSH over 25 on two occasions at least 4 weeks apart.
✔✔Anyone <40years old who misses 3+ consecutive cycles gets these labs -
✔✔prolactin
FSH
estradiol
TSH
pregnancy test
