NAMs Menopause Certification Exam
Questions With 100% Correct Answers
The period of endrocrinologic, somatic, and transitory psychologic changes that occur
around the time of menopause. - AnswerClimacteric phase
.LMP before age 45 - AnswerEarly menopause
.LMP after age 54 - AnswerLate menopause
.Menopause that occurs before age 40 - AnswerPrimary ovarian insufficiency
.Persistent difference of 7 days or more in the length of consecutive cycles. -
AnswerEarly menopause transition (stage -2)
.60 or more consecutive days of amenorrhea - AnswerLate menopause transition (stage
-1)
.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. -
AnswerLuteal out of phase event (LOOP)
.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) - AnswerObese women and estradiol levels during menopause
.These ethnic groups have lower estradiol levels then white, black and hispanic women.
- AnswerChinese and Japanese women
.late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased
genitourinary symptoms. - Answerstage +2
.early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS
predominate. - AnswerStages +1a, +1b, +1c
.Endocrine labs after menopause - AnswerElevated FSH, LH
.These hormones work during reproductive years to not deplete follicle pool too quickly.
- AnswerAMH, inhibin B
,.Menstrual cycle variable, persistent >7 day difference between difference in length of
consecutive cycles. - AnswerPhases during menopause transition and PMS symptoms
.many pitfalls, variable depending on the day of the cycle you draw the lab, normal or
low FSH is not helpful. - AnswerHow to respond if a patient requests FSH lab?
.AMH - AnswerThe potentially superior marker of menopause, a lab.
.Adrenal androgens: precursor hromones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in peripheral tissues. -
AnswerDHEA (dehydroepiandrosterone)
.Vagina, vulva, urethra, trigone of the bladder - AnswerLocation of estrogen receptors
.maintain blood flow, the collagen, and HA within the epithelial surfaces. Supports
microbiome which supports acidity of vagina and protects tissue from pathogens. -
AnswerEffects of estrogen on tissue
.Thinning, loss of elasticity, loss or absence or rugae. - AnswerVaginal changes with
menopause
.vagina narrows, urethra moves closer to the introitus. - AnswerVagina and urethra in
menopause
.Vaginal estrogen and urinary incontinence: what type does it help with? - AnswerStress
urinary incontinence
.Minoxidil, spironolactone, finasteride, estrogen therapy - AnswerTreatment for FPHL
.-3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low.
-3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low. -
AnswerLate reporoductive years -3b and -3a. What happens with menstrual cycles,
FSH, AMH, AFC, inhibin?
.Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level. -
AnswerWhen it is appropriate to check an FSH during the cycle if you check it? and
why?
.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. - AnswerAMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak?
.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. -
AnswerAFC
.25 or higher - AnswerLate menopause transition (-1) FSH level on random draw
.Higher - AnswerBlack women have higher or lower FSH levels?
.lower - AnswerChinese and Japanese women have higher or lower estradiol levels
compared to white, black and hispanic women?
.SHBG decreases
Testosterone/SHBG ratio increases by 80%. - AnswerMenopause transition-changes in
SHBG and testosterone? ratio?
.The free androgen index - AnswerTestosterone/SHGB ratio is called what?
.+1b (generally last 2 years) - AnswerWhat stage are VMS more likely?
.Estrone-via aromatization. - AnswerWhat hormone is generally higher in obese
women?
.testosterone and androstenedione - AnswerThe postmenopausal ovary continues to
produce what two hormones?
.testosterone. 40-50% lower than in women w/ intact ovaries. - AnswerSurgical
menopause causes women to have lower levels of what hormone?
.inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining,
diminished follicle pool. - AnswerDriving piece of menopause is ovarian follicles
depleting. What does this do to the inhibin B and AMH?
.Luteal-more PMS symptoms, more frequent menstrual periods. - AnswerIn the
menopause transition, women spend more time in what phase?
Questions With 100% Correct Answers
The period of endrocrinologic, somatic, and transitory psychologic changes that occur
around the time of menopause. - AnswerClimacteric phase
.LMP before age 45 - AnswerEarly menopause
.LMP after age 54 - AnswerLate menopause
.Menopause that occurs before age 40 - AnswerPrimary ovarian insufficiency
.Persistent difference of 7 days or more in the length of consecutive cycles. -
AnswerEarly menopause transition (stage -2)
.60 or more consecutive days of amenorrhea - AnswerLate menopause transition (stage
-1)
.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. -
AnswerLuteal out of phase event (LOOP)
.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) - AnswerObese women and estradiol levels during menopause
.These ethnic groups have lower estradiol levels then white, black and hispanic women.
- AnswerChinese and Japanese women
.late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased
genitourinary symptoms. - Answerstage +2
.early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS
predominate. - AnswerStages +1a, +1b, +1c
.Endocrine labs after menopause - AnswerElevated FSH, LH
.These hormones work during reproductive years to not deplete follicle pool too quickly.
- AnswerAMH, inhibin B
,.Menstrual cycle variable, persistent >7 day difference between difference in length of
consecutive cycles. - AnswerPhases during menopause transition and PMS symptoms
.many pitfalls, variable depending on the day of the cycle you draw the lab, normal or
low FSH is not helpful. - AnswerHow to respond if a patient requests FSH lab?
.AMH - AnswerThe potentially superior marker of menopause, a lab.
.Adrenal androgens: precursor hromones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in peripheral tissues. -
AnswerDHEA (dehydroepiandrosterone)
.Vagina, vulva, urethra, trigone of the bladder - AnswerLocation of estrogen receptors
.maintain blood flow, the collagen, and HA within the epithelial surfaces. Supports
microbiome which supports acidity of vagina and protects tissue from pathogens. -
AnswerEffects of estrogen on tissue
.Thinning, loss of elasticity, loss or absence or rugae. - AnswerVaginal changes with
menopause
.vagina narrows, urethra moves closer to the introitus. - AnswerVagina and urethra in
menopause
.Vaginal estrogen and urinary incontinence: what type does it help with? - AnswerStress
urinary incontinence
.Minoxidil, spironolactone, finasteride, estrogen therapy - AnswerTreatment for FPHL
.-3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low.
-3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low. -
AnswerLate reporoductive years -3b and -3a. What happens with menstrual cycles,
FSH, AMH, AFC, inhibin?
.Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level. -
AnswerWhen it is appropriate to check an FSH during the cycle if you check it? and
why?
.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. - AnswerAMH
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak?
.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. -
AnswerAFC
.25 or higher - AnswerLate menopause transition (-1) FSH level on random draw
.Higher - AnswerBlack women have higher or lower FSH levels?
.lower - AnswerChinese and Japanese women have higher or lower estradiol levels
compared to white, black and hispanic women?
.SHBG decreases
Testosterone/SHBG ratio increases by 80%. - AnswerMenopause transition-changes in
SHBG and testosterone? ratio?
.The free androgen index - AnswerTestosterone/SHGB ratio is called what?
.+1b (generally last 2 years) - AnswerWhat stage are VMS more likely?
.Estrone-via aromatization. - AnswerWhat hormone is generally higher in obese
women?
.testosterone and androstenedione - AnswerThe postmenopausal ovary continues to
produce what two hormones?
.testosterone. 40-50% lower than in women w/ intact ovaries. - AnswerSurgical
menopause causes women to have lower levels of what hormone?
.inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining,
diminished follicle pool. - AnswerDriving piece of menopause is ovarian follicles
depleting. What does this do to the inhibin B and AMH?
.Luteal-more PMS symptoms, more frequent menstrual periods. - AnswerIn the
menopause transition, women spend more time in what phase?
