NAMs Menopause Certification
Exam 2024
Climacteric phase - ANSWER The period of endrocrinologic,
somatic, and transitory psychologic changes that occur around the
time of menopause.
Early menopause - ANSWER LMP before age 45
Late menopause - ANSWER LMP after age 54
Primary ovarian insufficiency - ANSWER Menopause that occurs
before age 40
Early menopause transition (stage -2) - ANSWER Persistent
difference of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1) - ANSWER 60 or more
consecutive days of amenorrhea
Luteal out of phase event (LOOP) - ANSWER 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.
Obese women and estradiol levels during menopause - ANSWER
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)
Chinese and Japanese women - ANSWER These ethnic groups
have lower estradiol levels then white, black and hispanic women.
,stage +2 - ANSWER late menopause stage: 5-8 years after FMP.
Somatic aging predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - ANSWER early post menopause: 2 years
after FMP. FSH rises, estradiol decreases. VMS predominate.
Elevated FSH, LH - ANSWER Endocrine labs after menopause
AMH, inhibin B - ANSWER These hormones work during
reproductive years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms - ANSWER
Menstrual cycle shortenes, follicular phase compresses, women
spend more time in luteal phase.. meaning more premenstrual
symptoms and more frequent menstrual periods.
How to respond if a patient requests FSH lab? - ANSWER many
pitfalls, variable depending on the day of the cycle you draw the lab,
normal or low FSH is not helpful.
The potentially superior marker of menopause, a lab. - ANSWER
AMH
DHEA (dehydroepiandrosterone) - ANSWER Adrenal androgens:
precursor hromones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in
peripheral tissues.
Location of estrogen receptors - ANSWER Vagina, vulva, urethra,
trigone of the bladder
Effects of estrogen on tissue - ANSWER maintain blood flow, the
collagen, and HA within the epithelial surfaces. Supports microbiome
and protects tissue from pathogens.
Vaginal changes with menopause - ANSWER Thinning, loss of
elasticity, loss or absence or rugae.
Vagina and urethra in menopause - ANSWER vagina narrows,
urethra moves closer to the introitus.
, Stress urinary incontinence - ANSWER Vaginal estrogen and
urinary incontinence: what type does it help with?
Treatment for FPHL - ANSWER Minoxidil, spironolactone,
finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual
cycles, FSH, AMH, AFC, inhibin? - ANSWER -3b: menstrual cycles
normal, FSH normal, AMH low, AFC low, inhibin low.
-3a: subtle menstrual changes, variable FSH, AMH low, AFC low,
inhibin low.
When it is appropriate to check an FSH during the cycle if you check
it? and why? - ANSWER 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? - ANSWER 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 - ANSWER Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the
Exam 2024
Climacteric phase - ANSWER The period of endrocrinologic,
somatic, and transitory psychologic changes that occur around the
time of menopause.
Early menopause - ANSWER LMP before age 45
Late menopause - ANSWER LMP after age 54
Primary ovarian insufficiency - ANSWER Menopause that occurs
before age 40
Early menopause transition (stage -2) - ANSWER Persistent
difference of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1) - ANSWER 60 or more
consecutive days of amenorrhea
Luteal out of phase event (LOOP) - ANSWER 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.
Obese women and estradiol levels during menopause - ANSWER
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)
Chinese and Japanese women - ANSWER These ethnic groups
have lower estradiol levels then white, black and hispanic women.
,stage +2 - ANSWER late menopause stage: 5-8 years after FMP.
Somatic aging predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - ANSWER early post menopause: 2 years
after FMP. FSH rises, estradiol decreases. VMS predominate.
Elevated FSH, LH - ANSWER Endocrine labs after menopause
AMH, inhibin B - ANSWER These hormones work during
reproductive years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms - ANSWER
Menstrual cycle shortenes, follicular phase compresses, women
spend more time in luteal phase.. meaning more premenstrual
symptoms and more frequent menstrual periods.
How to respond if a patient requests FSH lab? - ANSWER many
pitfalls, variable depending on the day of the cycle you draw the lab,
normal or low FSH is not helpful.
The potentially superior marker of menopause, a lab. - ANSWER
AMH
DHEA (dehydroepiandrosterone) - ANSWER Adrenal androgens:
precursor hromones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in
peripheral tissues.
Location of estrogen receptors - ANSWER Vagina, vulva, urethra,
trigone of the bladder
Effects of estrogen on tissue - ANSWER maintain blood flow, the
collagen, and HA within the epithelial surfaces. Supports microbiome
and protects tissue from pathogens.
Vaginal changes with menopause - ANSWER Thinning, loss of
elasticity, loss or absence or rugae.
Vagina and urethra in menopause - ANSWER vagina narrows,
urethra moves closer to the introitus.
, Stress urinary incontinence - ANSWER Vaginal estrogen and
urinary incontinence: what type does it help with?
Treatment for FPHL - ANSWER Minoxidil, spironolactone,
finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual
cycles, FSH, AMH, AFC, inhibin? - ANSWER -3b: menstrual cycles
normal, FSH normal, AMH low, AFC low, inhibin low.
-3a: subtle menstrual changes, variable FSH, AMH low, AFC low,
inhibin low.
When it is appropriate to check an FSH during the cycle if you check
it? and why? - ANSWER 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? - ANSWER 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 - ANSWER Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the
