NAMS Certification Exam
1. Early Menopause FMP before age 45
2. Late Menopause FMP after age 54
3. Bilateral - All cause mortality
oophorectomy - Coronary heart disease
prior to age 45 - CVD
increases risks - Menopause symptoms
for: - Worsening mood symptoms
- Higher incidence of Parkinson Disease
- Associated with cognitive impairment
4. Early Menopause 7 or more days persistent difference in cycle length from previous normal cycle
Transition (-2) - Results of increased follicular aging and depletion
- Inhibin B decreases
- FSH increases (Variable)
5. LOOP Cycles Explains elevation of Estradiol in perimenopause
- Rising FSH levels recruit 2nd follicle during luteal phase which leads to overpro-
duction of Estradiol
- This causes menstrual changes in future cycles
6. Decreased AMH More frequent anovulatory cycles
in Early
Menopause Tran-
sition
7. Decreased Inhib- - Skipped menstrual cycles
in B in Early - Mastalgia
Menopause Tran- - Migraine
sition - Menorrhagia (with LOOP cycles)
- Endometrial Hyperplasia
, NAMS Certification Exam
8. Late Menopause 60 or more days of amenorrhea for women aged 45 years or older
Transition (-1) - Women 40-44 years with recurrent episodes of amenorrhea of 60 day for longer
within a year improves prediction of entry into late menopause transition
9. Late Menopause 1-3 years
Transition (-1)
Duration
10. Late Menopause VMS likely
Transition (-1)
Symptoms
11. STRAW Stage Late Menopause Transition (-1)
where FSH > 25
12. Elevated FSH - VMS
symptoms in - Sleep disturbance
Late Menopause - Changes in weight distribution
Transition - Increased variability in cycle length
13. Decreased Inhib- - Mood changes
in B in Late - Cognitive complaints
Menopause Tran- - Changes in sexual functioning
sition - Increased prevalence of anovulation
14. Decreased AMH - GSM
in Late - Bone loss
Menopause Tran- - CVD issues
sition - Interval of amenorrhea > 60 days
15. POI Menopause before age 40
16. POI diagnosis - Oligomenorrhea or amenorrhea x 4 months
- FSH > 25 on two occasions at least 4 weeks apart
, NAMS Certification Exam
17. POI Symptoms - Hot flashes
- Mood changes - depression
- Insomnia
- Vaginal dryness, dyspareunia
18. POI Manage- HT until average of menopause
ment
19. Early Menopause - CVD
Risks (natural or - Low bone density
surgical) - Memory for verbal information compromised
- Low libido due to decreased testosterone
- Depression due to fertility
20. Ovarian Reserve - Antral follicle count & AMH
Lab
21. Secondary - Pregnancy
Amenorrhea - Hypothalamic amenorrhea (e.g., Diabetes, celiac disease, excessive exer-
differential with cise/caloric restriction, stress, lesions of hypothalamus/pituitary)
low FSH - Hyperprolactinemia
- Thyroid disease
- PCOS
22. Adrenal Insuffi- - Hypofunction of adrenal gland and pituitary gland
ciency - Diagnosed by low cortisol at baseline
- Treatment includes glucocorticoid replacement
23. Female Pattern - Gradual hair thinning on crown of scalp
Hair Loss (FPHL) - Occurs due to altered estrogen-to-androgen ratio
- Sometimes seen with discontinuation of HT
24.
, NAMS Certification Exam
Telogen Effluvi- - Sudden hair shedding
um (TE) - Patchy hair loss
- Occurs after a major life stressor, chronic illness, or medication (beta blocker,
anticoagulant)
25. Hair Loss Treat- Goal: Prevent progression of hair loss
ment - Minoxidil is FDA approved
- Commonly used with Finasteride or Spironolactone
26. Window of Vul- Idea that women are exposed to hormone-related mood symptoms (e.g., PMS,
nerability PPD)
27. HT and Mood - Consider if VMS and mood changes
- Only consider if in perimenopause or early postmenopausal
28. Early - Duration is 2 years
Postmenopause - VMS likely
(+1a/+1b)
29. Early Post- - Duration 3-6 years
menopause (+1c) - FSH stabilizes
30. Late Post- - Remaining lifespan
menopause (+2) - Increasing symptoms of urogenital atrophy
31. Menopause and - Increased fat in abdominal region
weight - Decreased lean body mass
32. HT and weight - No effect on weight
- May result in favorable body fat distribution
33. When can you - BMI 27-29.9 with co-morbidity
consider medica- - BMI >30
1. Early Menopause FMP before age 45
2. Late Menopause FMP after age 54
3. Bilateral - All cause mortality
oophorectomy - Coronary heart disease
prior to age 45 - CVD
increases risks - Menopause symptoms
for: - Worsening mood symptoms
- Higher incidence of Parkinson Disease
- Associated with cognitive impairment
4. Early Menopause 7 or more days persistent difference in cycle length from previous normal cycle
Transition (-2) - Results of increased follicular aging and depletion
- Inhibin B decreases
- FSH increases (Variable)
5. LOOP Cycles Explains elevation of Estradiol in perimenopause
- Rising FSH levels recruit 2nd follicle during luteal phase which leads to overpro-
duction of Estradiol
- This causes menstrual changes in future cycles
6. Decreased AMH More frequent anovulatory cycles
in Early
Menopause Tran-
sition
7. Decreased Inhib- - Skipped menstrual cycles
in B in Early - Mastalgia
Menopause Tran- - Migraine
sition - Menorrhagia (with LOOP cycles)
- Endometrial Hyperplasia
, NAMS Certification Exam
8. Late Menopause 60 or more days of amenorrhea for women aged 45 years or older
Transition (-1) - Women 40-44 years with recurrent episodes of amenorrhea of 60 day for longer
within a year improves prediction of entry into late menopause transition
9. Late Menopause 1-3 years
Transition (-1)
Duration
10. Late Menopause VMS likely
Transition (-1)
Symptoms
11. STRAW Stage Late Menopause Transition (-1)
where FSH > 25
12. Elevated FSH - VMS
symptoms in - Sleep disturbance
Late Menopause - Changes in weight distribution
Transition - Increased variability in cycle length
13. Decreased Inhib- - Mood changes
in B in Late - Cognitive complaints
Menopause Tran- - Changes in sexual functioning
sition - Increased prevalence of anovulation
14. Decreased AMH - GSM
in Late - Bone loss
Menopause Tran- - CVD issues
sition - Interval of amenorrhea > 60 days
15. POI Menopause before age 40
16. POI diagnosis - Oligomenorrhea or amenorrhea x 4 months
- FSH > 25 on two occasions at least 4 weeks apart
, NAMS Certification Exam
17. POI Symptoms - Hot flashes
- Mood changes - depression
- Insomnia
- Vaginal dryness, dyspareunia
18. POI Manage- HT until average of menopause
ment
19. Early Menopause - CVD
Risks (natural or - Low bone density
surgical) - Memory for verbal information compromised
- Low libido due to decreased testosterone
- Depression due to fertility
20. Ovarian Reserve - Antral follicle count & AMH
Lab
21. Secondary - Pregnancy
Amenorrhea - Hypothalamic amenorrhea (e.g., Diabetes, celiac disease, excessive exer-
differential with cise/caloric restriction, stress, lesions of hypothalamus/pituitary)
low FSH - Hyperprolactinemia
- Thyroid disease
- PCOS
22. Adrenal Insuffi- - Hypofunction of adrenal gland and pituitary gland
ciency - Diagnosed by low cortisol at baseline
- Treatment includes glucocorticoid replacement
23. Female Pattern - Gradual hair thinning on crown of scalp
Hair Loss (FPHL) - Occurs due to altered estrogen-to-androgen ratio
- Sometimes seen with discontinuation of HT
24.
, NAMS Certification Exam
Telogen Effluvi- - Sudden hair shedding
um (TE) - Patchy hair loss
- Occurs after a major life stressor, chronic illness, or medication (beta blocker,
anticoagulant)
25. Hair Loss Treat- Goal: Prevent progression of hair loss
ment - Minoxidil is FDA approved
- Commonly used with Finasteride or Spironolactone
26. Window of Vul- Idea that women are exposed to hormone-related mood symptoms (e.g., PMS,
nerability PPD)
27. HT and Mood - Consider if VMS and mood changes
- Only consider if in perimenopause or early postmenopausal
28. Early - Duration is 2 years
Postmenopause - VMS likely
(+1a/+1b)
29. Early Post- - Duration 3-6 years
menopause (+1c) - FSH stabilizes
30. Late Post- - Remaining lifespan
menopause (+2) - Increasing symptoms of urogenital atrophy
31. Menopause and - Increased fat in abdominal region
weight - Decreased lean body mass
32. HT and weight - No effect on weight
- May result in favorable body fat distribution
33. When can you - BMI 27-29.9 with co-morbidity
consider medica- - BMI >30
