NAMS MENOPAUSE CERTIFICATION ACTUAL EXAM SCRIPT
2025/2026 QUESTIONS WITH ANSWERS GRADED A+
✔✔lower - ✔✔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%. - ✔✔Menopause transition-changes in
SHBG and testosterone? ratio?
✔✔The free androgen index - ✔✔Testosterone/SHGB ratio is called what?
✔✔+1b (generally last 2 years) - ✔✔What stage are VMS more likely?
✔✔Estrone-via aromatization. - ✔✔What hormone is generally higher in obese women?
✔✔testosterone and androstenedione - ✔✔The postmenopausal ovary continues to
produce what two hormones?
✔✔testosterone. 40-50% lower than in women w/ intact ovaries. - ✔✔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. - ✔✔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. - ✔✔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. - ✔✔HPO axis theory and the menopause transition
✔✔progesterone - ✔✔In the first year after the FMP, there is no production of what
hormone?
✔✔zona reticularis - ✔✔What region of the adrenal gland secretes the androgens?
✔✔DHEA, DHEAS, Androstenedione. - ✔✔what are considered the 'adrenal
androgens'?
,✔✔Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by
the anterior pituitary. - ✔✔Aldosterone secretion from the zona reticularis in the adrenal
gland is regulated by 3 main factors.
✔✔Anterior pituitary. The posterior only secretes vasopressin and oxytosin. - ✔✔What
part of the pituitary gland secretes adrenocorticotropic hormone?
✔✔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. - ✔✔Cortisol and HRT
✔✔No, cortisol levels have NOT been associated with more severe VMS. - ✔✔Do
cortisol levels associate with VMS severity?
✔✔vaginal pain and dyspareunia - ✔✔Local DHEA has been proven to help with what?
✔✔Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months.
AND
elevated FSH over 25 on two occasions at least 4 weeks apart. - ✔✔How to DX POI?
✔✔prolactin
FSH
estradiol
TSH
pregnancy test - ✔✔Anyone <40years old who misses 3+ consecutive cycles gets these
labs
✔✔100 microgram estradiol patch
1.25 mg CEE
2mg oral estradiol
If intact uterus-progesterone for 12 days of the month.
Physiologic is better than continuous hormonal contractption, but if menorrhagia-IUD
plus estrogen patch, or if really not wanting to risk pregnancy, continuous HRT can be
used. - ✔✔treatment of POI
, ✔✔FPHL is gradual, telogen effluvium is sudden and usually precipitated by a life
stressor, chronic illness, beta blockers or anticoagulants-usually more patchy hair loss. -
✔✔Hair loss. Difference between FPHL and telogen effluvium?
✔✔thinning at the crown of the head and widening of the hair part - ✔✔FPHL pattern
✔✔MINOXIDIL
spironolactone
finasteride - ✔✔Treating FPHL
✔✔Japanese - ✔✔What ethnicity has the least likely chance of having bad hot flashes?
✔✔black
more frequent, longer duration. - ✔✔What ethnicity is the most likely to have bad hot
flashes?
✔✔10 years, early menopause transition women have them the longest. - ✔✔Median
length of hot flashes
✔✔lower ovarian estradiol
thermoregulation zone is narrowed
neurokinins-regulate GnRH secretion. KNDy new meds
serotonin
cortisol and HPI axis dysregulation
endothelial dysfunction. - ✔✔Theories about etiology of hot flashes (6)
✔✔low grade is not precancerous
high grade is precancerous-GYN ONC
differentiated-wide local excision-high risk of invasive carcinoma. - ✔✔VIN
low grade-what to do
high grade-what to do
differentiated VIN-what to do
✔✔squamous cell carcinoma - ✔✔most common type of vulvar cancer
✔✔paget's disease
will not improve on steroids
screen for co-existing breast, GI or GU cancer. They are present 20-30% of the time. -
✔✔Vulvar disorder commonly misdiagnosed as eczema or dermatitis?
✔✔<100mL - ✔✔Normal PVR
2025/2026 QUESTIONS WITH ANSWERS GRADED A+
✔✔lower - ✔✔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%. - ✔✔Menopause transition-changes in
SHBG and testosterone? ratio?
✔✔The free androgen index - ✔✔Testosterone/SHGB ratio is called what?
✔✔+1b (generally last 2 years) - ✔✔What stage are VMS more likely?
✔✔Estrone-via aromatization. - ✔✔What hormone is generally higher in obese women?
✔✔testosterone and androstenedione - ✔✔The postmenopausal ovary continues to
produce what two hormones?
✔✔testosterone. 40-50% lower than in women w/ intact ovaries. - ✔✔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. - ✔✔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. - ✔✔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. - ✔✔HPO axis theory and the menopause transition
✔✔progesterone - ✔✔In the first year after the FMP, there is no production of what
hormone?
✔✔zona reticularis - ✔✔What region of the adrenal gland secretes the androgens?
✔✔DHEA, DHEAS, Androstenedione. - ✔✔what are considered the 'adrenal
androgens'?
,✔✔Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by
the anterior pituitary. - ✔✔Aldosterone secretion from the zona reticularis in the adrenal
gland is regulated by 3 main factors.
✔✔Anterior pituitary. The posterior only secretes vasopressin and oxytosin. - ✔✔What
part of the pituitary gland secretes adrenocorticotropic hormone?
✔✔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. - ✔✔Cortisol and HRT
✔✔No, cortisol levels have NOT been associated with more severe VMS. - ✔✔Do
cortisol levels associate with VMS severity?
✔✔vaginal pain and dyspareunia - ✔✔Local DHEA has been proven to help with what?
✔✔Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months.
AND
elevated FSH over 25 on two occasions at least 4 weeks apart. - ✔✔How to DX POI?
✔✔prolactin
FSH
estradiol
TSH
pregnancy test - ✔✔Anyone <40years old who misses 3+ consecutive cycles gets these
labs
✔✔100 microgram estradiol patch
1.25 mg CEE
2mg oral estradiol
If intact uterus-progesterone for 12 days of the month.
Physiologic is better than continuous hormonal contractption, but if menorrhagia-IUD
plus estrogen patch, or if really not wanting to risk pregnancy, continuous HRT can be
used. - ✔✔treatment of POI
, ✔✔FPHL is gradual, telogen effluvium is sudden and usually precipitated by a life
stressor, chronic illness, beta blockers or anticoagulants-usually more patchy hair loss. -
✔✔Hair loss. Difference between FPHL and telogen effluvium?
✔✔thinning at the crown of the head and widening of the hair part - ✔✔FPHL pattern
✔✔MINOXIDIL
spironolactone
finasteride - ✔✔Treating FPHL
✔✔Japanese - ✔✔What ethnicity has the least likely chance of having bad hot flashes?
✔✔black
more frequent, longer duration. - ✔✔What ethnicity is the most likely to have bad hot
flashes?
✔✔10 years, early menopause transition women have them the longest. - ✔✔Median
length of hot flashes
✔✔lower ovarian estradiol
thermoregulation zone is narrowed
neurokinins-regulate GnRH secretion. KNDy new meds
serotonin
cortisol and HPI axis dysregulation
endothelial dysfunction. - ✔✔Theories about etiology of hot flashes (6)
✔✔low grade is not precancerous
high grade is precancerous-GYN ONC
differentiated-wide local excision-high risk of invasive carcinoma. - ✔✔VIN
low grade-what to do
high grade-what to do
differentiated VIN-what to do
✔✔squamous cell carcinoma - ✔✔most common type of vulvar cancer
✔✔paget's disease
will not improve on steroids
screen for co-existing breast, GI or GU cancer. They are present 20-30% of the time. -
✔✔Vulvar disorder commonly misdiagnosed as eczema or dermatitis?
✔✔<100mL - ✔✔Normal PVR
