NAMS MENOPAUSE CERTIFICATION
EXAM 2026 QUESTIONS AND
AMNSWERS WITH COMPLETE
SOLUTIONS 100% CORRECT RATED
A+
What is the clinical definition of the climacteric phase?
✔✔ Answer: The overall window of time surrounding menopause during which a
person undergoes a mix of physical, hormonal, and temporary psychological shifts.
Under the STRAW+10 staging system, what is the early menopausal
transition stage and how is it identified?
✔✔ Answer: This is Stage -2. It is clinically identified when a person experiences
a persistent difference of 7 days or more in the length of consecutive menstrual
cycles.
Under the STRAW+10 staging system, what is the late menopausal transition
stage and how is it identified?
✔✔ Answer: This is Stage -1. It is clinically defined by experiencing a gap of 60
or more consecutive days of amenorrhea (no menstrual bleeding).
Luteal out of phase event (LOOP)
Explains why some perimenopausal women have elevated estrogen level
sometimes...In the early menopause transition, elevated FSH levels 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.
Describe the E2 level during the life of a patient with obesity.
,They are also more likely to have lower premenopause/perimenopausal estradiol
levels compared to patients with average BMIs. However, the level is the highest
in postmenopausal patients with obesity.
In comparison to other ethnicities, Chinese and Japanese women have ___ E2
levels?
These ethnic groups have lower estradiol levels than white, black and hispanic
women.
STRAW Stage +2, describe the timeline as well as the predominant symptoms.
Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c, describe the timeline as well as the supportive criteria and
the symptoms.
Postmenopause, Early. 2 years after FMP.
+1a/b (2yrs) FSH variable where as the AMH and InhB are low. The AFC are very
low. VMS predominate.
1c (3-6yrs) FSH levels stabilize. The other measures continue as previous.
Elevated FSH, LH
Endocrine labs after menopause
,AMH, Inhibin B
These hormones work during reproductive years to not deplete follicle pool too
quickly.
Describe the phases during the early menopause transition and what happens with
PMS symptoms
Menstrual cycle shortens. Due to unrestrained FSH, follicular phase compresses.
More premenstrual symptoms due to the longer luteal phase. Cycle irregularity and
skipped cycles because of ovulatory failure and increased atresia.
How to respond if a patient requests FSH lab?
many pitfalls, variable depending on the day of the cycle you draw the lab, normal
or low FSH is not helpful.
What lab is potentially the superior marker of time to menopause?
AMH
DHEA (dehydroepiandrosterone)
Adrenal androgens: precursor hromones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in peripheral tissues.
Location of GU estrogen receptors (4)
, Vagina, vulva, urethra, trigone of the bladder
List the effects of estrogen on tissue (4+2)
1 ) maintains blood flow to tissue, maintains the collagen within the epithelium,
and maintains the hyaluronic acid and mucopolysaccharides within the moistened
epithelial surface, maintains pH (4.5) 2) supports microbiome and protects tissue
from pathogens
List the vaginal changes with menopause you might note on clinical/microscopic
exam.
Thinning of the epithelial layer, loss of elasticity with narrowing of the canal and
poor distention, noted on pelvic exam with loss or absence or rugae. Due to the
decrease in glycogen content, the lactobacilli are decreased resulting in higher pH.
List the vulvar and urethral changes in menopause.
Thinning of the epithelial layers and vagina narrowing leads the urethra to move
closer to the introitus.
Stress urinary incontinence
Vaginal estrogen and urinary incontinence: what type does it help with?
Treatment for FPHL
Minoxidil, spironolactone, finasteride, estrogen therapy
EXAM 2026 QUESTIONS AND
AMNSWERS WITH COMPLETE
SOLUTIONS 100% CORRECT RATED
A+
What is the clinical definition of the climacteric phase?
✔✔ Answer: The overall window of time surrounding menopause during which a
person undergoes a mix of physical, hormonal, and temporary psychological shifts.
Under the STRAW+10 staging system, what is the early menopausal
transition stage and how is it identified?
✔✔ Answer: This is Stage -2. It is clinically identified when a person experiences
a persistent difference of 7 days or more in the length of consecutive menstrual
cycles.
Under the STRAW+10 staging system, what is the late menopausal transition
stage and how is it identified?
✔✔ Answer: This is Stage -1. It is clinically defined by experiencing a gap of 60
or more consecutive days of amenorrhea (no menstrual bleeding).
Luteal out of phase event (LOOP)
Explains why some perimenopausal women have elevated estrogen level
sometimes...In the early menopause transition, elevated FSH levels 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.
Describe the E2 level during the life of a patient with obesity.
,They are also more likely to have lower premenopause/perimenopausal estradiol
levels compared to patients with average BMIs. However, the level is the highest
in postmenopausal patients with obesity.
In comparison to other ethnicities, Chinese and Japanese women have ___ E2
levels?
These ethnic groups have lower estradiol levels than white, black and hispanic
women.
STRAW Stage +2, describe the timeline as well as the predominant symptoms.
Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c, describe the timeline as well as the supportive criteria and
the symptoms.
Postmenopause, Early. 2 years after FMP.
+1a/b (2yrs) FSH variable where as the AMH and InhB are low. The AFC are very
low. VMS predominate.
1c (3-6yrs) FSH levels stabilize. The other measures continue as previous.
Elevated FSH, LH
Endocrine labs after menopause
,AMH, Inhibin B
These hormones work during reproductive years to not deplete follicle pool too
quickly.
Describe the phases during the early menopause transition and what happens with
PMS symptoms
Menstrual cycle shortens. Due to unrestrained FSH, follicular phase compresses.
More premenstrual symptoms due to the longer luteal phase. Cycle irregularity and
skipped cycles because of ovulatory failure and increased atresia.
How to respond if a patient requests FSH lab?
many pitfalls, variable depending on the day of the cycle you draw the lab, normal
or low FSH is not helpful.
What lab is potentially the superior marker of time to menopause?
AMH
DHEA (dehydroepiandrosterone)
Adrenal androgens: precursor hromones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in peripheral tissues.
Location of GU estrogen receptors (4)
, Vagina, vulva, urethra, trigone of the bladder
List the effects of estrogen on tissue (4+2)
1 ) maintains blood flow to tissue, maintains the collagen within the epithelium,
and maintains the hyaluronic acid and mucopolysaccharides within the moistened
epithelial surface, maintains pH (4.5) 2) supports microbiome and protects tissue
from pathogens
List the vaginal changes with menopause you might note on clinical/microscopic
exam.
Thinning of the epithelial layer, loss of elasticity with narrowing of the canal and
poor distention, noted on pelvic exam with loss or absence or rugae. Due to the
decrease in glycogen content, the lactobacilli are decreased resulting in higher pH.
List the vulvar and urethral changes in menopause.
Thinning of the epithelial layers and vagina narrowing leads the urethra to move
closer to the introitus.
Stress urinary incontinence
Vaginal estrogen and urinary incontinence: what type does it help with?
Treatment for FPHL
Minoxidil, spironolactone, finasteride, estrogen therapy
