NAMS EXAM SCRIPT VERIFIED QUESTIONS
WITH COMPLETE SOLUTION REVIEW
●● Early menopause
Answer: LMP before age 45
●● Late menopause
Answer: LMP after age 54
●● Primary ovarian insufficiency
Answer: Menopause that occurs before age 40
●● 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 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
Answer: 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
Answer: These ethnic groups have lower estradiol levels then white,
black and hispanic women.
●● stage +2
Answer: late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
●● Stages +1a, +1b, +1c
Answer: early post menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
●● 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, normal or low FSH is not helpful.
●● The potentially superior marker of menopause, a lab.
Answer: AMH
●● DHEA (dehydroepiandrosterone)
Answer: 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
, Answer: Vagina, vulva, urethra, trigone of the bladder
●● Effects of estrogen on tissue
Answer: 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
Answer: Thinning, loss of elasticity, loss or absence or 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 reporoductive years -3b and -3a. What happens with menstrual
cycles, FSH, AMH, AFC, inhibin?
WITH COMPLETE SOLUTION REVIEW
●● Early menopause
Answer: LMP before age 45
●● Late menopause
Answer: LMP after age 54
●● Primary ovarian insufficiency
Answer: Menopause that occurs before age 40
●● 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 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
Answer: 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
Answer: These ethnic groups have lower estradiol levels then white,
black and hispanic women.
●● stage +2
Answer: late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
●● Stages +1a, +1b, +1c
Answer: early post menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
●● 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, normal or low FSH is not helpful.
●● The potentially superior marker of menopause, a lab.
Answer: AMH
●● DHEA (dehydroepiandrosterone)
Answer: 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
, Answer: Vagina, vulva, urethra, trigone of the bladder
●● Effects of estrogen on tissue
Answer: 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
Answer: Thinning, loss of elasticity, loss or absence or 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 reporoductive years -3b and -3a. What happens with menstrual
cycles, FSH, AMH, AFC, inhibin?
