NAMs Menopause Certification Exam
Climacteric phase - ANSThe period of endrocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
Early menopause - ANSLMP before age 45
Late menopause - ANSLMP after age 54
Primary ovarian insufficiency - ANSMenopause that occurs before age 40
Early menopause transition (stage -2) - ANSPersistent difference of 7 days or more in the length
of consecutive cycles.
Late menopause transition (stage -1) - ANS60 or more consecutive days of amenorrhea
Luteal out of phase event (LOOP) - ANSExplains 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 - ANSObese 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 - ANSThese ethnic groups have lower estradiol levels then
white, black and hispanic women.
stage +2 - ANSlate menopause stage: 5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.
Stages +1a, +1b, +1c - ANSearly post menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
Elevated FSH, LH - ANSEndocrine labs after menopause
AMH, inhibin B - ANSThese hormones work during reproductive years to not deplete follicle
pool too quickly.
, Phases during menopause transition and PMS symptoms - ANSMenstrual 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? - ANSmany 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. - ANSAMH
DHEA (dehydroepiandrosterone) - ANSAdrenal androgens: precursor hromones produced by
the adrenal gland that are enzymatically converted to active androgens or estrogens in
peripheral tissues.
Location of estrogen receptors - ANSVagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - ANSmaintain blood flow, the collagen, and HA within the
epithelial surfaces. Supports microbiome and protects tissue from pathogens.
Vaginal changes with menopause - ANSThinning, loss of elasticity, loss or absence or rugae.
Vagina and urethra in menopause - ANSvagina narrows, urethra moves closer to the introitus.
Stress urinary incontinence - ANSVaginal estrogen and urinary incontinence: what type does it
help with?
Treatment for FPHL - ANSMinoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC,
inhibin? - ANS-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? - ANSCycle
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? - ANSproduced by granulosa cells
used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low ovarian
reserve.
Climacteric phase - ANSThe period of endrocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
Early menopause - ANSLMP before age 45
Late menopause - ANSLMP after age 54
Primary ovarian insufficiency - ANSMenopause that occurs before age 40
Early menopause transition (stage -2) - ANSPersistent difference of 7 days or more in the length
of consecutive cycles.
Late menopause transition (stage -1) - ANS60 or more consecutive days of amenorrhea
Luteal out of phase event (LOOP) - ANSExplains 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 - ANSObese 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 - ANSThese ethnic groups have lower estradiol levels then
white, black and hispanic women.
stage +2 - ANSlate menopause stage: 5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.
Stages +1a, +1b, +1c - ANSearly post menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
Elevated FSH, LH - ANSEndocrine labs after menopause
AMH, inhibin B - ANSThese hormones work during reproductive years to not deplete follicle
pool too quickly.
, Phases during menopause transition and PMS symptoms - ANSMenstrual 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? - ANSmany 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. - ANSAMH
DHEA (dehydroepiandrosterone) - ANSAdrenal androgens: precursor hromones produced by
the adrenal gland that are enzymatically converted to active androgens or estrogens in
peripheral tissues.
Location of estrogen receptors - ANSVagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - ANSmaintain blood flow, the collagen, and HA within the
epithelial surfaces. Supports microbiome and protects tissue from pathogens.
Vaginal changes with menopause - ANSThinning, loss of elasticity, loss or absence or rugae.
Vagina and urethra in menopause - ANSvagina narrows, urethra moves closer to the introitus.
Stress urinary incontinence - ANSVaginal estrogen and urinary incontinence: what type does it
help with?
Treatment for FPHL - ANSMinoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC,
inhibin? - ANS-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? - ANSCycle
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? - ANSproduced by granulosa cells
used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low ovarian
reserve.
