NAMs MENOPAUSE CERTIFICATION EXAM
ACTUAL EXAM 250 QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+
The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of
menopause. - CORRECT ANSWER>>Climacteric phase
LMP before age 45 - CORRECT ANSWER>>Early menopause
LMP after age 54 - CORRECT ANSWER>>Late menopause
Menopause that occurs before age 40 - CORRECT ANSWER>>Primary ovarian insufficiency
Persistent difference of 7 days or more in the length of consecutive cycles. - CORRECT ANSWER>>Early
menopause transition (stage -2)
60 or more consecutive days of amenorrhea - CORRECT ANSWER>>Late 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. - CORRECT ANSWER>>Luteal 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) - CORRECT ANSWER>>Obese women
and estradiol levels during menopause
These ethnic groups have lower estradiol levels then white, black and hispanic women. - CORRECT
ANSWER>>Chinese and Japanese women
late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary
symptoms. - CORRECT ANSWER>>stage +2
early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate. - CORRECT
ANSWER>>Stages +1a, +1b, +1c
Endocrine labs after menopause - CORRECT ANSWER>>Elevated FSH, LH
These hormones work during reproductive years to not deplete follicle pool too quickly. - CORRECT
ANSWER>>AMH, inhibin B
Menstrual cycle variable, persistent >7 day difference between difference in length of consecutive cycles.
- CORRECT ANSWER>>Phases 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. - CORRECT ANSWER>>How to respond if a patient requests FSH lab?
AMH - CORRECT ANSWER>>The 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. - CORRECT ANSWER>>DHEA
(dehydroepiandrosterone)
Vagina, vulva, urethra, trigone of the bladder - CORRECT ANSWER>>Location 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. - CORRECT ANSWER>>Effects of estrogen
on tissue
Thinning, loss of elasticity, loss or absence or rugae. - CORRECT ANSWER>>Vaginal changes with
menopause
vagina narrows, urethra moves closer to the introitus. - CORRECT ANSWER>>Vagina and urethra in
menopause
Vaginal estrogen and urinary incontinence: what type does it help with? - CORRECT ANSWER>>Stress
urinary incontinence
Minoxidil, spironolactone, finasteride, estrogen therapy - CORRECT ANSWER>>Treatment 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. - CORRECT ANSWER>>Late
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. - CORRECT
ANSWER>>When 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. - CORRECT ANSWER>>AMH
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. - CORRECT
ANSWER>>AFC
25 or higher - CORRECT ANSWER>>Late menopause transition (-1) FSH level on random draw
Higher - CORRECT ANSWER>>Black women have higher or lower FSH levels?
lower - CORRECT ANSWER>>Chinese and Japanese women have higher or lower estradiol levels
compared to white, black and hispanic women?
SHBG decreases
Testosterone/SHBG ratio increases by 80%. - CORRECT ANSWER>>Menopause transition-changes in
SHBG and testosterone? ratio?
The free androgen index - CORRECT ANSWER>>Testosterone/SHGB ratio is called what?
+1b (generally last 2 years) - CORRECT ANSWER>>What stage are VMS more likely?
Estrone-via aromatization. - CORRECT ANSWER>>What hormone is generally higher in obese women?
testosterone and androstenedione - CORRECT ANSWER>>The postmenopausal ovary continues to
produce what two hormones?
testosterone. 40-50% lower than in women w/ intact ovaries. - CORRECT ANSWER>>Surgical 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. - CORRECT ANSWER>>Driving 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. - CORRECT ANSWER>>In the
menopause transition, women spend more time in what phase?
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. - CORRECT
ANSWER>>HPO axis theory and the menopause transition
progesterone - CORRECT ANSWER>>In the first year after the FMP, there is no production of what
hormone?
zona reticularis - CORRECT ANSWER>>What region of the adrenal gland secretes the androgens?
ACTUAL EXAM 250 QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+
The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of
menopause. - CORRECT ANSWER>>Climacteric phase
LMP before age 45 - CORRECT ANSWER>>Early menopause
LMP after age 54 - CORRECT ANSWER>>Late menopause
Menopause that occurs before age 40 - CORRECT ANSWER>>Primary ovarian insufficiency
Persistent difference of 7 days or more in the length of consecutive cycles. - CORRECT ANSWER>>Early
menopause transition (stage -2)
60 or more consecutive days of amenorrhea - CORRECT ANSWER>>Late 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. - CORRECT ANSWER>>Luteal 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) - CORRECT ANSWER>>Obese women
and estradiol levels during menopause
These ethnic groups have lower estradiol levels then white, black and hispanic women. - CORRECT
ANSWER>>Chinese and Japanese women
late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary
symptoms. - CORRECT ANSWER>>stage +2
early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate. - CORRECT
ANSWER>>Stages +1a, +1b, +1c
Endocrine labs after menopause - CORRECT ANSWER>>Elevated FSH, LH
These hormones work during reproductive years to not deplete follicle pool too quickly. - CORRECT
ANSWER>>AMH, inhibin B
Menstrual cycle variable, persistent >7 day difference between difference in length of consecutive cycles.
- CORRECT ANSWER>>Phases 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. - CORRECT ANSWER>>How to respond if a patient requests FSH lab?
AMH - CORRECT ANSWER>>The 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. - CORRECT ANSWER>>DHEA
(dehydroepiandrosterone)
Vagina, vulva, urethra, trigone of the bladder - CORRECT ANSWER>>Location 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. - CORRECT ANSWER>>Effects of estrogen
on tissue
Thinning, loss of elasticity, loss or absence or rugae. - CORRECT ANSWER>>Vaginal changes with
menopause
vagina narrows, urethra moves closer to the introitus. - CORRECT ANSWER>>Vagina and urethra in
menopause
Vaginal estrogen and urinary incontinence: what type does it help with? - CORRECT ANSWER>>Stress
urinary incontinence
Minoxidil, spironolactone, finasteride, estrogen therapy - CORRECT ANSWER>>Treatment 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. - CORRECT ANSWER>>Late
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. - CORRECT
ANSWER>>When 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. - CORRECT ANSWER>>AMH
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. - CORRECT
ANSWER>>AFC
25 or higher - CORRECT ANSWER>>Late menopause transition (-1) FSH level on random draw
Higher - CORRECT ANSWER>>Black women have higher or lower FSH levels?
lower - CORRECT ANSWER>>Chinese and Japanese women have higher or lower estradiol levels
compared to white, black and hispanic women?
SHBG decreases
Testosterone/SHBG ratio increases by 80%. - CORRECT ANSWER>>Menopause transition-changes in
SHBG and testosterone? ratio?
The free androgen index - CORRECT ANSWER>>Testosterone/SHGB ratio is called what?
+1b (generally last 2 years) - CORRECT ANSWER>>What stage are VMS more likely?
Estrone-via aromatization. - CORRECT ANSWER>>What hormone is generally higher in obese women?
testosterone and androstenedione - CORRECT ANSWER>>The postmenopausal ovary continues to
produce what two hormones?
testosterone. 40-50% lower than in women w/ intact ovaries. - CORRECT ANSWER>>Surgical 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. - CORRECT ANSWER>>Driving 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. - CORRECT ANSWER>>In the
menopause transition, women spend more time in what phase?
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. - CORRECT
ANSWER>>HPO axis theory and the menopause transition
progesterone - CORRECT ANSWER>>In the first year after the FMP, there is no production of what
hormone?
zona reticularis - CORRECT ANSWER>>What region of the adrenal gland secretes the androgens?
