NAMS MENOPAUSE CERTIFICATION EXAM PREP QUESTIONS
350 COMPREHENSIVE QUESTIONS WITH DETAILED ANSWERS
1. How should a clinician respond when a patient requests FSH lab
testing?
There are many pitfalls and variability in FSH testing. Results can be
misleading due to cyclic fluctuations, and FSH alone is not diagnostic of
menopause status. Clinicians should explain the limitations of single FSH
measurements and consider clinical symptoms and other markers.
2. What is the potentially superior laboratory marker of menopause?
AMH (Anti-Müllerian Hormone) is considered a superior marker as it
more reliably reflects ovarian reserve and declines with age, becoming
undetectable in menopause.
3. What are adrenal androgens and where are they produced?
Adrenal androgens are precursor hormones including DHEA, DHEAS,
and androstenedione produced by the adrenal gland's zona reticularis.
They are enzymatically converted to active androgens or estrogens in
peripheral tissues.
4. Where are estrogen receptors located in the pelvic region?
Estrogen receptors are located in the vagina, vulva, urethra, and trigone
of the bladder.
,5. What are the effects of estrogen on tissue?
Estrogen maintains blood flow, collagen, and hyaluronic acid within
epithelial surfaces. It supports the microbiome and protects tissue from
pathogens.
6. What vaginal changes occur with menopause?
Thinning of vaginal epithelium, loss of elasticity, and loss or absence of
rugae (vaginal folds).
7. How does the vagina and urethra change anatomically in
menopause?
The vagina narrows and the urethra moves closer to the introitus
(vaginal opening).
8. What type of urinary incontinence does vaginal estrogen help with?
Vaginal estrogen helps with stress urinary incontinence.
9. What are the treatment options for Female Pattern Hair Loss
(FPHL)?
Minoxidil, spironolactone, finasteride, and estrogen therapy.
10. What are the characteristics of late reproductive years stage -3b?
Menstrual cycles are normal, FSH is normal, AMH is low, AFC (antral
follicle count) is low, and inhibin is low.
,11. What are the characteristics of late reproductive years stage -3a?
Subtle menstrual changes occur, FSH is variable, AMH is low, AFC is low,
and inhibin is low.
12. When is it appropriate to check FSH during the menstrual cycle
and why?
Cycle day 3 is the appropriate time. Elevated estradiol can suppress FSH
giving a falsely normal level, so checking early in the cycle avoids this
interference.
13. Where is AMH produced and what is it used to test?
AMH is produced by granulosa cells and is used to test damage to
ovarian follicle reserve. Low AMH indicates low ovarian reserve.
14. Is AMH recommended as a screening tool to predict fertility?
No, AMH is not recommended as a screening tool to predict fertility.
15. When does AMH peak?
AMH peaks at around age 25 years. Before age 25, testing is not helpful.
16. What is the climacteric phase?
The period of endocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
, 17. What defines early menopause?
Last menstrual period (LMP) before age 45.
18. What defines late menopause?
Last menstrual period (LMP) after age 54.
19. What is primary ovarian insufficiency?
Menopause that occurs before age 40.
20. What characterizes the early menopause transition (stage -2)?
Persistent difference of 7 days or more in the length of consecutive
cycles.
21. What characterizes the late menopause transition (stage -1)?
60 or more consecutive days of amenorrhea.
22. What is a Luteal Out of Phase (LOOP) event?
In the early menopause transition, elevated FSH levels adequately
recruit a second follicle, resulting in a follicular phase-like rise in
estradiol secretion superimposed on the mid-to-late luteal phase of the
ongoing ovulatory cycle. This explains why some perimenopausal
women have elevated estrogen levels.
350 COMPREHENSIVE QUESTIONS WITH DETAILED ANSWERS
1. How should a clinician respond when a patient requests FSH lab
testing?
There are many pitfalls and variability in FSH testing. Results can be
misleading due to cyclic fluctuations, and FSH alone is not diagnostic of
menopause status. Clinicians should explain the limitations of single FSH
measurements and consider clinical symptoms and other markers.
2. What is the potentially superior laboratory marker of menopause?
AMH (Anti-Müllerian Hormone) is considered a superior marker as it
more reliably reflects ovarian reserve and declines with age, becoming
undetectable in menopause.
3. What are adrenal androgens and where are they produced?
Adrenal androgens are precursor hormones including DHEA, DHEAS,
and androstenedione produced by the adrenal gland's zona reticularis.
They are enzymatically converted to active androgens or estrogens in
peripheral tissues.
4. Where are estrogen receptors located in the pelvic region?
Estrogen receptors are located in the vagina, vulva, urethra, and trigone
of the bladder.
,5. What are the effects of estrogen on tissue?
Estrogen maintains blood flow, collagen, and hyaluronic acid within
epithelial surfaces. It supports the microbiome and protects tissue from
pathogens.
6. What vaginal changes occur with menopause?
Thinning of vaginal epithelium, loss of elasticity, and loss or absence of
rugae (vaginal folds).
7. How does the vagina and urethra change anatomically in
menopause?
The vagina narrows and the urethra moves closer to the introitus
(vaginal opening).
8. What type of urinary incontinence does vaginal estrogen help with?
Vaginal estrogen helps with stress urinary incontinence.
9. What are the treatment options for Female Pattern Hair Loss
(FPHL)?
Minoxidil, spironolactone, finasteride, and estrogen therapy.
10. What are the characteristics of late reproductive years stage -3b?
Menstrual cycles are normal, FSH is normal, AMH is low, AFC (antral
follicle count) is low, and inhibin is low.
,11. What are the characteristics of late reproductive years stage -3a?
Subtle menstrual changes occur, FSH is variable, AMH is low, AFC is low,
and inhibin is low.
12. When is it appropriate to check FSH during the menstrual cycle
and why?
Cycle day 3 is the appropriate time. Elevated estradiol can suppress FSH
giving a falsely normal level, so checking early in the cycle avoids this
interference.
13. Where is AMH produced and what is it used to test?
AMH is produced by granulosa cells and is used to test damage to
ovarian follicle reserve. Low AMH indicates low ovarian reserve.
14. Is AMH recommended as a screening tool to predict fertility?
No, AMH is not recommended as a screening tool to predict fertility.
15. When does AMH peak?
AMH peaks at around age 25 years. Before age 25, testing is not helpful.
16. What is the climacteric phase?
The period of endocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
, 17. What defines early menopause?
Last menstrual period (LMP) before age 45.
18. What defines late menopause?
Last menstrual period (LMP) after age 54.
19. What is primary ovarian insufficiency?
Menopause that occurs before age 40.
20. What characterizes the early menopause transition (stage -2)?
Persistent difference of 7 days or more in the length of consecutive
cycles.
21. What characterizes the late menopause transition (stage -1)?
60 or more consecutive days of amenorrhea.
22. What is a Luteal Out of Phase (LOOP) event?
In the early menopause transition, elevated FSH levels adequately
recruit a second follicle, resulting in a follicular phase-like rise in
estradiol secretion superimposed on the mid-to-late luteal phase of the
ongoing ovulatory cycle. This explains why some perimenopausal
women have elevated estrogen levels.
