NAMS MENOPAUSE CERTIFICATION EXAM QUESTIONS WITH 100% CORRECT ANSWERS/NEWEST UPDATE/GRADE A+ ASSURED.
Climacteric phase ✔️The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of menopause.
Early menopause ✔️LMP before age 45
Late menopause ✔️LMP after age 54
Primary ovarian insufficiency ✔️Menopause that occurs before age 40
Early menopause transition (stage -2) ✔️Persistent difference of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1) ✔️60 or more consecutive days of amenorrhea
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.
Obese women and estradiol levels during menopause ✔️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 ✔️These ethnic groups have lower estradiol levels then white, black and hispanic women.
stage +2 ✔️late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c ✔️early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate.
Elevated FSH, LH ✔️Endocrine labs after menopause
AMH, inhibin B ✔️These hormones work during reproductive years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms ✔️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? ✔️many pitfalls, variable depending on the day of the cycle you draw the lab, normal or low FSH is
not helpful.
The potentially superior marker of menopause, a lab. ✔️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 estrogen receptors ✔️Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue ✔️maintain blood flow, the collagen, and HA within the epithelial surfaces. Supports microbiome and protects
tissue from pathogens.
Vaginal changes with menopause ✔️Thinning, loss of elasticity, loss or absence or rugae.
Vagina and urethra in menopause ✔️vagina narrows, urethra moves 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
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? ✔️-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? and why? ✔️Cycle day #3. Elevated estradiol can suppress FSH giving a
falsely normal FSH level.
, AMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak? ✔️produced by granulosa cells
used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low ovarian reserve.
not recommended as a screening tool to predict fertility.
Peaks at around 25 years old. So before age 25, this test is not helpful.
It is influenced by exogenous hormones. Lower in hormonal contraception users, but increases after d/cing.
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
Climacteric phase ✔️The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of menopause.
Early menopause ✔️LMP before age 45
Late menopause ✔️LMP after age 54
Primary ovarian insufficiency ✔️Menopause that occurs before age 40
Early menopause transition (stage -2) ✔️Persistent difference of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1) ✔️60 or more consecutive days of amenorrhea
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.
Obese women and estradiol levels during menopause ✔️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 ✔️These ethnic groups have lower estradiol levels then white, black and hispanic women.
stage +2 ✔️late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c ✔️early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate.
Elevated FSH, LH ✔️Endocrine labs after menopause
AMH, inhibin B ✔️These hormones work during reproductive years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms ✔️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? ✔️many pitfalls, variable depending on the day of the cycle you draw the lab, normal or low FSH is
not helpful.
The potentially superior marker of menopause, a lab. ✔️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 estrogen receptors ✔️Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue ✔️maintain blood flow, the collagen, and HA within the epithelial surfaces. Supports microbiome and protects
tissue from pathogens.
Vaginal changes with menopause ✔️Thinning, loss of elasticity, loss or absence or rugae.
Vagina and urethra in menopause ✔️vagina narrows, urethra moves 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
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? ✔️-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? and why? ✔️Cycle day #3. Elevated estradiol can suppress FSH giving a
falsely normal FSH level.
, AMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak? ✔️produced by granulosa cells
used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low ovarian reserve.
not recommended as a screening tool to predict fertility.
Peaks at around 25 years old. So before age 25, this test is not helpful.
It is influenced by exogenous hormones. Lower in hormonal contraception users, but increases after d/cing.
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
