NAMs Menopause Certification Exam With Complete
Solutions Latest updates
When it is appropriate to check an FSH during the cycle if you check it? and why? -
✔✔Cycle 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? - ✔✔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.
,AFC - ✔✔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.
Late menopause transition (-1) FSH level on random draw - ✔✔25 or higher
Black women have higher or lower FSH levels? - ✔✔Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and hispanic women? - ✔✔lower
Menopause transition-changes in SHBG and testosterone? ratio? - ✔✔SHBG
decreases Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what? - ✔✔The free androgen index
What stage are VMS more likely? - ✔✔+1b (generally last 2 years)
What hormone is generally higher in obese women? - ✔✔Estrone-via aromatization.
,The postmenopausal ovary continues to produce what two hormones? - ✔✔testosterone
and androstenedione
Surgical menopause causes women to have lower levels of what hormone? - ✔✔testosterone.
40-50% lower than in women w/ intact ovaries.
Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B
and AMH? - ✔✔inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the
remaining, diminished follicle pool.
In the menopause transition, women spend more time in what phase? - ✔✔Luteal-more
PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition - ✔✔It is felt that the HPO axis may become
less sensitive to estrogen, so even with good follicle growth and estradiol secretion, LH surges
can fail which can lead to more cycle irregularity.
In the first year after the FMP, there is no production of what hormone? - ✔✔progesterone
What region of the adrenal gland secretes the androgens? - ✔✔zona reticularis
what are considered the 'adrenal androgens'? - ✔✔DHEA, DHEAS, Androstenedione.
, Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main
factors. - ✔✔Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted
by the anterior pituitary.
What part of the pituitary gland secretes adrenocorticotropic hormone? - ✔✔Anterior pituitary.
The posterior only secretes vasopressin and oxytosin.
Cortisol and HRT - ✔✔Most serum cortisol circulates bound to cortisol binding globulin.
Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol concentration.
Do cortisol levels associate with VMS severity? - ✔✔No, cortisol levels have NOT
been associated with more severe VMS.
Local DHEA has been proven to help with what? - ✔✔vaginal pain and dyspareunia
How to DX POI? - ✔✔Menstrual disturbance-oligomenorrhea or amenorrhea for at least
4 months.
Solutions Latest updates
When it is appropriate to check an FSH during the cycle if you check it? and why? -
✔✔Cycle 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? - ✔✔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.
,AFC - ✔✔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.
Late menopause transition (-1) FSH level on random draw - ✔✔25 or higher
Black women have higher or lower FSH levels? - ✔✔Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and hispanic women? - ✔✔lower
Menopause transition-changes in SHBG and testosterone? ratio? - ✔✔SHBG
decreases Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what? - ✔✔The free androgen index
What stage are VMS more likely? - ✔✔+1b (generally last 2 years)
What hormone is generally higher in obese women? - ✔✔Estrone-via aromatization.
,The postmenopausal ovary continues to produce what two hormones? - ✔✔testosterone
and androstenedione
Surgical menopause causes women to have lower levels of what hormone? - ✔✔testosterone.
40-50% lower than in women w/ intact ovaries.
Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B
and AMH? - ✔✔inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the
remaining, diminished follicle pool.
In the menopause transition, women spend more time in what phase? - ✔✔Luteal-more
PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition - ✔✔It is felt that the HPO axis may become
less sensitive to estrogen, so even with good follicle growth and estradiol secretion, LH surges
can fail which can lead to more cycle irregularity.
In the first year after the FMP, there is no production of what hormone? - ✔✔progesterone
What region of the adrenal gland secretes the androgens? - ✔✔zona reticularis
what are considered the 'adrenal androgens'? - ✔✔DHEA, DHEAS, Androstenedione.
, Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main
factors. - ✔✔Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted
by the anterior pituitary.
What part of the pituitary gland secretes adrenocorticotropic hormone? - ✔✔Anterior pituitary.
The posterior only secretes vasopressin and oxytosin.
Cortisol and HRT - ✔✔Most serum cortisol circulates bound to cortisol binding globulin.
Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol concentration.
Do cortisol levels associate with VMS severity? - ✔✔No, cortisol levels have NOT
been associated with more severe VMS.
Local DHEA has been proven to help with what? - ✔✔vaginal pain and dyspareunia
How to DX POI? - ✔✔Menstrual disturbance-oligomenorrhea or amenorrhea for at least
4 months.
