NAMS Menopause Certification Exam Study Set
1. # of ultrasound detected follicles 2-10 mm in size: AFC (antral follicle count)
2. normal AFC: >12
3. Luteal-Out-Of-Phase (LOOP) event: - FSH elevation recruits follicles for thesubsequent
cycle before the current cycle is over
- Excess estradiol production as new follicles start growing
- Increase chance of TWINS
- Very short follicular phase
- More time spent in luteal phase (more PMS/PMDD sx)
4. secondary causes of osteoporosis
which 3 common drugs?: Hyperthyroidism, hyperparathyroidism, hypercalciuria,certain drugs
(eg: tamoxifen, steroids, PPIs), calcium/vitamin D deficiency, RA, celiac disease,
malabsorptive diseases such as Crohn disease, and ulcerative colitis
5. Median age of menopause in US women: 52.54 y
6. POI: Intermittent ovarian function & insufficient estrogen levels occurring at age
<40 y
7. which STRAW stage?
menarche / early reproductive: -5
8. which STRAW stage?
peak reproductive: -4
9. which STRAW stage?
late reproductive: -3
10. which STRAW stage?
perimenopause: -2 to -1 & +1a
11. which STRAW stage?
FMP &
12 months after final menstrual period: FMP = 012 months after = +1a
12. which STRAW stage?
VMS most likely: +1a (most likely)
-1 (likely)
aka perimenopause/menopause transition
,13. which STRAW stage?
early post menopause: +1a to +1c
14. which STRAW stage?
late postmenopause: +2
15. which STRAW stage?
amenorrhea >60 days: -1
aka late menopause transition
16. which STRAW stage?
variable cycle lengths of >7 days differences: -2aka early menopause transition
17. difference between menopause transition vs perimenopause per STRAWcriteria?:
menopause transition: -2 and -1, prior to FMP
perimenopause: -2 to +1a, includes 12 mo of amenorrhea following FMP
18. which STRAW stage?
initial drop in AMH/AFC/inhibin, cycles still regular, FSH normal: -3baka late reproductive
19. which STRAW stage?
cycles shorter, first increase in FSH: -3aaka late reproductive
20. levels spike with ovulation, marker of ovarian reserve: inhibin B
21. Produced by granulosa cells of activated follicles, most reflective of true ovarian reserve;
provides the best single prediction of time to menopause: -AMH
22. what day of cycle to draw FSH to predict ovarian response/reserve?: day 3
23. normal day 3 FSH?
FSH value for menopause?: < 10
>25
, 24. symptoms of LOOP event: —Mastalgia
—Worsening migraine
—Growing fibroids
—Risk of endometrial hyperplasia
- longer time in luteal phase (worsening PMDD in peri)
25. premenopausal vs postmenopausal estradiol levels in obesity: pre: lower,more
anovulatory cycles
post: higher
26. consequence of inhibin B and AMH drop in early menopause transition?-
: FSH spikes --> fast growth of remaining follicles (twins more likely) --> shorterfollicular
phase --> follicle atresia --> LOOP cycles --> pronounced PMS sx fromlonger luteal phase -->
cycle irregularity by >7 days
27. dec ovarian reserve causes the drop in what 2 hormones?: inhibin B andAMH
28. 4 adrenal androgens: —Dehydroepiandrosterone (DHEA)
—Dehydroepiandrosterone sulfate (DHEAS)
—Androstenedione
—Testosterone
29. where are adrenal androgens converted to estrogen?: peripheral tissue
30. what happens to DHEA levels during menopause transition?: transientincrease then return
to premenopause baseline
31. is DHEA supplementation in menopause recommended?: no
(Systematic review and meta-analysis of DHEA use in postmenopausal women withnormal
adrenal function found no evidence of improvement in sexual symptoms, serum lipids, serum
glucose, weight, or bone mineral density)
32. dx of POI?: amenorrhea >4 mo in age <40FSH >25 on 2 occasions
33. 4 etiologies of POI
most common?: (1) Genetic (turner, fragile X)
(2) Autoimmune (adrenal Ab/Addison's)
(3) Cancer (chemo, radiation, surgical oophrectomy)
(4) Idiopathic --> most common
34. most common genetic cause of POI?: Turner syndrome/X chromosome ab-normalities
35. treatment for Turner syndrome with delayed puberty?: Started estrogenreplacement at age
12, add progestin at age of menarche
1. # of ultrasound detected follicles 2-10 mm in size: AFC (antral follicle count)
2. normal AFC: >12
3. Luteal-Out-Of-Phase (LOOP) event: - FSH elevation recruits follicles for thesubsequent
cycle before the current cycle is over
- Excess estradiol production as new follicles start growing
- Increase chance of TWINS
- Very short follicular phase
- More time spent in luteal phase (more PMS/PMDD sx)
4. secondary causes of osteoporosis
which 3 common drugs?: Hyperthyroidism, hyperparathyroidism, hypercalciuria,certain drugs
(eg: tamoxifen, steroids, PPIs), calcium/vitamin D deficiency, RA, celiac disease,
malabsorptive diseases such as Crohn disease, and ulcerative colitis
5. Median age of menopause in US women: 52.54 y
6. POI: Intermittent ovarian function & insufficient estrogen levels occurring at age
<40 y
7. which STRAW stage?
menarche / early reproductive: -5
8. which STRAW stage?
peak reproductive: -4
9. which STRAW stage?
late reproductive: -3
10. which STRAW stage?
perimenopause: -2 to -1 & +1a
11. which STRAW stage?
FMP &
12 months after final menstrual period: FMP = 012 months after = +1a
12. which STRAW stage?
VMS most likely: +1a (most likely)
-1 (likely)
aka perimenopause/menopause transition
,13. which STRAW stage?
early post menopause: +1a to +1c
14. which STRAW stage?
late postmenopause: +2
15. which STRAW stage?
amenorrhea >60 days: -1
aka late menopause transition
16. which STRAW stage?
variable cycle lengths of >7 days differences: -2aka early menopause transition
17. difference between menopause transition vs perimenopause per STRAWcriteria?:
menopause transition: -2 and -1, prior to FMP
perimenopause: -2 to +1a, includes 12 mo of amenorrhea following FMP
18. which STRAW stage?
initial drop in AMH/AFC/inhibin, cycles still regular, FSH normal: -3baka late reproductive
19. which STRAW stage?
cycles shorter, first increase in FSH: -3aaka late reproductive
20. levels spike with ovulation, marker of ovarian reserve: inhibin B
21. Produced by granulosa cells of activated follicles, most reflective of true ovarian reserve;
provides the best single prediction of time to menopause: -AMH
22. what day of cycle to draw FSH to predict ovarian response/reserve?: day 3
23. normal day 3 FSH?
FSH value for menopause?: < 10
>25
, 24. symptoms of LOOP event: —Mastalgia
—Worsening migraine
—Growing fibroids
—Risk of endometrial hyperplasia
- longer time in luteal phase (worsening PMDD in peri)
25. premenopausal vs postmenopausal estradiol levels in obesity: pre: lower,more
anovulatory cycles
post: higher
26. consequence of inhibin B and AMH drop in early menopause transition?-
: FSH spikes --> fast growth of remaining follicles (twins more likely) --> shorterfollicular
phase --> follicle atresia --> LOOP cycles --> pronounced PMS sx fromlonger luteal phase -->
cycle irregularity by >7 days
27. dec ovarian reserve causes the drop in what 2 hormones?: inhibin B andAMH
28. 4 adrenal androgens: —Dehydroepiandrosterone (DHEA)
—Dehydroepiandrosterone sulfate (DHEAS)
—Androstenedione
—Testosterone
29. where are adrenal androgens converted to estrogen?: peripheral tissue
30. what happens to DHEA levels during menopause transition?: transientincrease then return
to premenopause baseline
31. is DHEA supplementation in menopause recommended?: no
(Systematic review and meta-analysis of DHEA use in postmenopausal women withnormal
adrenal function found no evidence of improvement in sexual symptoms, serum lipids, serum
glucose, weight, or bone mineral density)
32. dx of POI?: amenorrhea >4 mo in age <40FSH >25 on 2 occasions
33. 4 etiologies of POI
most common?: (1) Genetic (turner, fragile X)
(2) Autoimmune (adrenal Ab/Addison's)
(3) Cancer (chemo, radiation, surgical oophrectomy)
(4) Idiopathic --> most common
34. most common genetic cause of POI?: Turner syndrome/X chromosome ab-normalities
35. treatment for Turner syndrome with delayed puberty?: Started estrogenreplacement at age
12, add progestin at age of menarche
