NAMs Menopause Certification Exam
Questions And Correct Answers 2025\2026 A+
Grade
Climacteric phase
- accurate answers-The period of endocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause
- accurate answers-LMP before age 45
Late menopause
- accurate answers-LMP after age 54
Primary ovarian insufficiency
- accurate answers-Menopause that occurs before age 40
Early menopause transition (stage -2)
- accurate answers-Persistent difference of 7 days or more in the length of
consecutive cycles.
Late menopause transition (stage -1)
- accurate answers-60 or more consecutive days of amenorrhea
Luteal out of phase event (LOOP)
- accurate answers-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
- accurate answers-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
- accurate answers-These ethnic groups have lower estradiol levels then
white, black and hispanic women.
stage +2
- accurate answers-late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c
- accurate answers-early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
Elevated FSH, LH
- accurate answers-Endocrine labs after menopause
AMH, inhibin B
- accurate answers-These hormones work during reproductive years to not
deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms
- accurate answers-Menstrual cycle variable, persistent >7 day difference
between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab?
- accurate answers-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.
- accurate answers-AMH
DHEA (dehydroepiandrosterone)
- accurate answers-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
- accurate answers-Vagina, vulva, urethra, trigone of the bladder
,Effects of estrogen on tissue
- accurate answers-maintain blood flow, the collagen, and HA within the
epithelial surfaces. Supports microbiome which supports acidity of vagina and
protects tissue from pathogens.
Vaginal changes with menopause
- accurate answers-Thinning, loss of elasticity, loss or absence or rugae.
Vagina and urethra in menopause
- accurate answers-vagina narrows, urethra moves closer to the introitus.
Stress urinary incontinence
- accurate answers-Vaginal estrogen and urinary incontinence: what type
does it help with?
Treatment for FPHL
- accurate answers-Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles,
FSH, AMH, AFC, inhibin?
- accurate answers--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?
- accurate answers-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?
- accurate answers-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
- accurate answers-Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability pool of
follicles.
Late menopause transition (-1) FSH level on random draw
- accurate answers-25 or higher
Black women have higher or lower FSH levels?
- accurate answers-Higher
Chinese and Japanese women have higher or lower estradiol levels compared
to white, black and hispanic women?
- accurate answers-lower
Menopause transition-changes in SHBG and testosterone? ratio?
- accurate answers-SHBG decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what?
- accurate answers-The free androgen index
What stage are VMS more likely?
- accurate answers-+1b (generally last 2 years)
What hormone is generally higher in obese women?
- accurate answers-Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones?
- accurate answers-testosterone and androstenedione
Questions And Correct Answers 2025\2026 A+
Grade
Climacteric phase
- accurate answers-The period of endocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause
- accurate answers-LMP before age 45
Late menopause
- accurate answers-LMP after age 54
Primary ovarian insufficiency
- accurate answers-Menopause that occurs before age 40
Early menopause transition (stage -2)
- accurate answers-Persistent difference of 7 days or more in the length of
consecutive cycles.
Late menopause transition (stage -1)
- accurate answers-60 or more consecutive days of amenorrhea
Luteal out of phase event (LOOP)
- accurate answers-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
- accurate answers-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
- accurate answers-These ethnic groups have lower estradiol levels then
white, black and hispanic women.
stage +2
- accurate answers-late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c
- accurate answers-early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
Elevated FSH, LH
- accurate answers-Endocrine labs after menopause
AMH, inhibin B
- accurate answers-These hormones work during reproductive years to not
deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms
- accurate answers-Menstrual cycle variable, persistent >7 day difference
between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab?
- accurate answers-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.
- accurate answers-AMH
DHEA (dehydroepiandrosterone)
- accurate answers-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
- accurate answers-Vagina, vulva, urethra, trigone of the bladder
,Effects of estrogen on tissue
- accurate answers-maintain blood flow, the collagen, and HA within the
epithelial surfaces. Supports microbiome which supports acidity of vagina and
protects tissue from pathogens.
Vaginal changes with menopause
- accurate answers-Thinning, loss of elasticity, loss or absence or rugae.
Vagina and urethra in menopause
- accurate answers-vagina narrows, urethra moves closer to the introitus.
Stress urinary incontinence
- accurate answers-Vaginal estrogen and urinary incontinence: what type
does it help with?
Treatment for FPHL
- accurate answers-Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles,
FSH, AMH, AFC, inhibin?
- accurate answers--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?
- accurate answers-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?
- accurate answers-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
- accurate answers-Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability pool of
follicles.
Late menopause transition (-1) FSH level on random draw
- accurate answers-25 or higher
Black women have higher or lower FSH levels?
- accurate answers-Higher
Chinese and Japanese women have higher or lower estradiol levels compared
to white, black and hispanic women?
- accurate answers-lower
Menopause transition-changes in SHBG and testosterone? ratio?
- accurate answers-SHBG decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what?
- accurate answers-The free androgen index
What stage are VMS more likely?
- accurate answers-+1b (generally last 2 years)
What hormone is generally higher in obese women?
- accurate answers-Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones?
- accurate answers-testosterone and androstenedione
