1|Page
NAMS MENOPAUSE CERTIFICATION EXAM QUESTIONS
AND ANSWERS (LATEST VERSION VERIFIED FOR
ACCURACY) | 2026\2027 LATEST!! (VERIFIED ANSWERS)
STUDY GUIDE
Early menopause transition (stage -2) ......ANSWER......Persistent
difference of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1) ......ANSWER......60 or more
consecutive days of amenorrhea.
Luteal out of phase event (LOOP) ......ANSWER......Explains why some
perimenopausal women have elevated estrogen levels sometimes.
Obese women and estradiol levels during menopause
......ANSWER......Obese women are more likely to have anovulatory
cycles with high estradiol levels.
Chinese and Japanese women ......ANSWER......These ethnic groups
have lower estradiol levels than white, black, and Hispanic women.
Stage +2 ......ANSWER......Late menopause stage: 5-8 years after FMP.
Somatic aging predominates.
,2|Page
Stages +1a, +1b, +1c ......ANSWER......Early post menopause: 2 years
after FMP. FSH rises, estradiol decreases.
Elevated FSH, LH ......ANSWER......Endocrine labs after menopause.
AMH, inhibin B ......ANSWER......These hormones work during
reproductive years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms
......ANSWER......Menstrual cycle variable, persistent >7 day difference
between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? ......ANSWER......Many
pitfalls, variable depending on the day of the cycle you draw the lab.
The potentially superior marker of menopause, a lab.
......ANSWER......AMH.
DHEA (dehydroepiandrosterone) ......ANSWER......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 ......ANSWER......Vagina, vulva, urethra,
trigone of the bladder.
,3|Page
Effects of estrogen on tissue ......ANSWER......Maintain blood flow, the
collagen, and HA within the epithelial surfaces.
Vaginal changes with menopause ......ANSWER......Thinning, loss of
elasticity, loss or absence of rugae.
Vagina and urethra in menopause ......ANSWER......Vagina narrows,
urethra moves closer to the introitus.
Stress urinary incontinence ......ANSWER......Vaginal estrogen and
urinary incontinence: what type does it help with?
Treatment for FPHL ......ANSWER......Minoxidil, spironolactone,
finasteride, estrogen therapy.
Late reproductive years -3b and -3a ......ANSWER......-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?
......ANSWER......Cycle day #3. Elevated estradiol can suppress FSH giving
a falsely normal FSH level.
, 4|Page
AFC ......ANSWER......Antral follicle count. Number of follicles that are
detectable with ultrasound.
Late menopause transition (-1) FSH level on random draw
......ANSWER......25 or higher.
Black women have higher or lower FSH levels? ......ANSWER......Higher.
Chinese and Japanese women have higher or lower estradiol levels
compared to white, black and Hispanic women? ......ANSWER......Lower.
Menopause transition-changes in SHBG and testosterone?
......ANSWER......SHBG decreases. Testosterone/SHBG ratio increases by
80%.
Testosterone/SHBG ratio is called what? ......ANSWER......The free
androgen index.
What stage are VMS more likely? ......ANSWER......+1b (generally last 2
years).
What hormone is generally higher in obese women?
......ANSWER......Estrone-via aromatization.
NAMS MENOPAUSE CERTIFICATION EXAM QUESTIONS
AND ANSWERS (LATEST VERSION VERIFIED FOR
ACCURACY) | 2026\2027 LATEST!! (VERIFIED ANSWERS)
STUDY GUIDE
Early menopause transition (stage -2) ......ANSWER......Persistent
difference of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1) ......ANSWER......60 or more
consecutive days of amenorrhea.
Luteal out of phase event (LOOP) ......ANSWER......Explains why some
perimenopausal women have elevated estrogen levels sometimes.
Obese women and estradiol levels during menopause
......ANSWER......Obese women are more likely to have anovulatory
cycles with high estradiol levels.
Chinese and Japanese women ......ANSWER......These ethnic groups
have lower estradiol levels than white, black, and Hispanic women.
Stage +2 ......ANSWER......Late menopause stage: 5-8 years after FMP.
Somatic aging predominates.
,2|Page
Stages +1a, +1b, +1c ......ANSWER......Early post menopause: 2 years
after FMP. FSH rises, estradiol decreases.
Elevated FSH, LH ......ANSWER......Endocrine labs after menopause.
AMH, inhibin B ......ANSWER......These hormones work during
reproductive years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms
......ANSWER......Menstrual cycle variable, persistent >7 day difference
between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? ......ANSWER......Many
pitfalls, variable depending on the day of the cycle you draw the lab.
The potentially superior marker of menopause, a lab.
......ANSWER......AMH.
DHEA (dehydroepiandrosterone) ......ANSWER......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 ......ANSWER......Vagina, vulva, urethra,
trigone of the bladder.
,3|Page
Effects of estrogen on tissue ......ANSWER......Maintain blood flow, the
collagen, and HA within the epithelial surfaces.
Vaginal changes with menopause ......ANSWER......Thinning, loss of
elasticity, loss or absence of rugae.
Vagina and urethra in menopause ......ANSWER......Vagina narrows,
urethra moves closer to the introitus.
Stress urinary incontinence ......ANSWER......Vaginal estrogen and
urinary incontinence: what type does it help with?
Treatment for FPHL ......ANSWER......Minoxidil, spironolactone,
finasteride, estrogen therapy.
Late reproductive years -3b and -3a ......ANSWER......-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?
......ANSWER......Cycle day #3. Elevated estradiol can suppress FSH giving
a falsely normal FSH level.
, 4|Page
AFC ......ANSWER......Antral follicle count. Number of follicles that are
detectable with ultrasound.
Late menopause transition (-1) FSH level on random draw
......ANSWER......25 or higher.
Black women have higher or lower FSH levels? ......ANSWER......Higher.
Chinese and Japanese women have higher or lower estradiol levels
compared to white, black and Hispanic women? ......ANSWER......Lower.
Menopause transition-changes in SHBG and testosterone?
......ANSWER......SHBG decreases. Testosterone/SHBG ratio increases by
80%.
Testosterone/SHBG ratio is called what? ......ANSWER......The free
androgen index.
What stage are VMS more likely? ......ANSWER......+1b (generally last 2
years).
What hormone is generally higher in obese women?
......ANSWER......Estrone-via aromatization.
