NAMS CERTIFICATION EXAM 2026
QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS 100%
CORRECT!!!
Clinical Definitions of Timing
How is the age of onset for early and late natural menopause clinically
defined?
✔✔ Answer:
Early Menopause: When the final menstrual period (FMP) occurs naturally
between the ages of 40 and 45.
Late Menopause: When the final menstrual period occurs naturally after the
age of 54.
Risks of Premature Surgical Menopause
A 42-year-old patient is counseling with her physician regarding a
recommended bilateral oophorectomy. What long-term health risks are
significantly increased when a bilateral oophorectomy is performed prior to
age 45?
✔✔ Answer:
Undergoing a bilateral oophorectomy (surgical removal of both ovaries) before the
age of 45 causes an abrupt, premature loss of estrogen, which significantly elevates
the risk for several systemic complications:
Cardiovascular Disease: Increased risk of coronary heart disease (CHD)
and overall cardiovascular disease (CVD) due to the loss of estrogen's
protective effect on the vascular system.
Mortality: Higher rates of all-cause mortality.
Neurological & Cognitive Decline: A higher incidence of Parkinson's
disease, cognitive impairment, and dementia.
, Severe Symptomatology: More intense, immediate vasomotor symptoms
(hot flashes, night sweats) and a higher likelihood of worsening mood
symptoms (such as depression or anxiety).
STRAW Stage -2 (Early Menopause Transition)
Under the STRAW staging system, what characterizes Stage -2 (the Early
Menopause Transition), and what are its physiological markers?
✔✔ Answer:
Menstrual Pattern: It is defined by a persistent difference of 7 or more
days in menstrual cycle length compared to the patient's previous normal
cycle.
Underlying Pathophysiology: This phase is driven by progressive ovarian
follicular aging and a depleted oocyte pool.
Hormonal Biomarkers:
o Inhibin B: Levels decrease significantly as the number of active
follicles declines.
o FSH (Follicle-Stimulating Hormone): Levels rise in a variable,
fluctuating manner due to the loss of negative feedback from
declining Inhibin B.
LOOP Cycles
Explains elevation of Estradiol in perimenopause
- Rising FSH levels recruit 2nd follicle during luteal phase which leads to
overproduction of Estradiol
- This causes menstrual changes in future cycles
Decreased AMH in Early Menopause Transition
, More frequent anovulatory cycles
Decreased Inhibin B in Early Menopause Transition
- Skipped menstrual cycles
- Mastalgia
- Migraine
- Menorrhagia (with LOOP cycles)
- Endometrial Hyperplasia
Late Menopause Transition (-1)
60 or more days of amenorrhea for women aged 45 years or older
- Women 40-44 years with recurrent episodes of amenorrhea of 60 day for longer
within a year improves prediction of entry into late menopause transition
Late Menopause Transition (-1) Duration
1-3 years
Late Menopause Transition (-1) Symptoms
VMS likely
STRAW Stage where FSH > 25
QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS 100%
CORRECT!!!
Clinical Definitions of Timing
How is the age of onset for early and late natural menopause clinically
defined?
✔✔ Answer:
Early Menopause: When the final menstrual period (FMP) occurs naturally
between the ages of 40 and 45.
Late Menopause: When the final menstrual period occurs naturally after the
age of 54.
Risks of Premature Surgical Menopause
A 42-year-old patient is counseling with her physician regarding a
recommended bilateral oophorectomy. What long-term health risks are
significantly increased when a bilateral oophorectomy is performed prior to
age 45?
✔✔ Answer:
Undergoing a bilateral oophorectomy (surgical removal of both ovaries) before the
age of 45 causes an abrupt, premature loss of estrogen, which significantly elevates
the risk for several systemic complications:
Cardiovascular Disease: Increased risk of coronary heart disease (CHD)
and overall cardiovascular disease (CVD) due to the loss of estrogen's
protective effect on the vascular system.
Mortality: Higher rates of all-cause mortality.
Neurological & Cognitive Decline: A higher incidence of Parkinson's
disease, cognitive impairment, and dementia.
, Severe Symptomatology: More intense, immediate vasomotor symptoms
(hot flashes, night sweats) and a higher likelihood of worsening mood
symptoms (such as depression or anxiety).
STRAW Stage -2 (Early Menopause Transition)
Under the STRAW staging system, what characterizes Stage -2 (the Early
Menopause Transition), and what are its physiological markers?
✔✔ Answer:
Menstrual Pattern: It is defined by a persistent difference of 7 or more
days in menstrual cycle length compared to the patient's previous normal
cycle.
Underlying Pathophysiology: This phase is driven by progressive ovarian
follicular aging and a depleted oocyte pool.
Hormonal Biomarkers:
o Inhibin B: Levels decrease significantly as the number of active
follicles declines.
o FSH (Follicle-Stimulating Hormone): Levels rise in a variable,
fluctuating manner due to the loss of negative feedback from
declining Inhibin B.
LOOP Cycles
Explains elevation of Estradiol in perimenopause
- Rising FSH levels recruit 2nd follicle during luteal phase which leads to
overproduction of Estradiol
- This causes menstrual changes in future cycles
Decreased AMH in Early Menopause Transition
, More frequent anovulatory cycles
Decreased Inhibin B in Early Menopause Transition
- Skipped menstrual cycles
- Mastalgia
- Migraine
- Menorrhagia (with LOOP cycles)
- Endometrial Hyperplasia
Late Menopause Transition (-1)
60 or more days of amenorrhea for women aged 45 years or older
- Women 40-44 years with recurrent episodes of amenorrhea of 60 day for longer
within a year improves prediction of entry into late menopause transition
Late Menopause Transition (-1) Duration
1-3 years
Late Menopause Transition (-1) Symptoms
VMS likely
STRAW Stage where FSH > 25
