NAMS Certification Exam 2025 (Graded A+) correct
Answered Questions A+ ASSURANCE
Climacteric phase Correct Answer ✅ The period of endrocrinologic,
somatic, and transitory psychologic changes that occur around the time of
menopause.
Early menopause Correct Answer ✅ LMP before age 45
Late menopause Correct Answer ✅ LMP after age 54
Primary ovarian insufficiency Correct Answer ✅ Menopause that occurs
before age 40 Early menopause transition (stage -2) Correct Answer ✅
Persistent difference of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1) Correct Answer ✅ 60 or more
consecutive days of amenorrhea
Luteal out of phase event (LOOP) Correct 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.
pg. 1
,Obese women and estradiol levels during menopause Correct 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 Correct Answer ✅ These ethnic groups
have lower estradiol levels then white, black and hispanic women.
stage +2 Correct Answer ✅ late menopause stage: 5-8 years after FMP.
Somatic aging predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c Correct Answer ✅ early post menopause: 2 years
after FMP. FSH rises, estradiol decreases. VMS predominate.
Elevated FSH, LH Correct Answer ✅ Endocrine labs after menopause
AMH, inhibin B Correct Answer ✅ These hormones work during
reproductive years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms Correct Answer ✅
Menstrual cycle shortenes, follicular phase compresses, women spend more
time in luteal phase.. meaning more premenstrual symptoms and more frequent
menstrual periods.
pg. 2
, How to respond if a patient requests FSH lab? Correct 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. Correct Answer
✅ AMH DHEA (dehydroepiandrosterone) Correct 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 Correct Answer ✅ Vagina, vulva, urethra,
trigone of the bladder
Effects of estrogen on tissue Correct Answer ✅ maintain blood flow, the
collagen, and HA within the epithelial surfaces. Supports microbiome and
protects tissue from pathogens.
Vaginal changes with menopause Correct Answer ✅ Thinning, loss of
elasticity, loss or absence or rugae.
Vagina and urethra in menopause Correct Answer ✅ vagina narrows,
urethra moves closer to the introitus.
Stress urinary incontinence Correct Answer ✅ Vaginal estrogen and
urinary incontinence: what type does it help with?
pg. 3
Answered Questions A+ ASSURANCE
Climacteric phase Correct Answer ✅ The period of endrocrinologic,
somatic, and transitory psychologic changes that occur around the time of
menopause.
Early menopause Correct Answer ✅ LMP before age 45
Late menopause Correct Answer ✅ LMP after age 54
Primary ovarian insufficiency Correct Answer ✅ Menopause that occurs
before age 40 Early menopause transition (stage -2) Correct Answer ✅
Persistent difference of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1) Correct Answer ✅ 60 or more
consecutive days of amenorrhea
Luteal out of phase event (LOOP) Correct 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.
pg. 1
,Obese women and estradiol levels during menopause Correct 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 Correct Answer ✅ These ethnic groups
have lower estradiol levels then white, black and hispanic women.
stage +2 Correct Answer ✅ late menopause stage: 5-8 years after FMP.
Somatic aging predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c Correct Answer ✅ early post menopause: 2 years
after FMP. FSH rises, estradiol decreases. VMS predominate.
Elevated FSH, LH Correct Answer ✅ Endocrine labs after menopause
AMH, inhibin B Correct Answer ✅ These hormones work during
reproductive years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms Correct Answer ✅
Menstrual cycle shortenes, follicular phase compresses, women spend more
time in luteal phase.. meaning more premenstrual symptoms and more frequent
menstrual periods.
pg. 2
, How to respond if a patient requests FSH lab? Correct 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. Correct Answer
✅ AMH DHEA (dehydroepiandrosterone) Correct 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 Correct Answer ✅ Vagina, vulva, urethra,
trigone of the bladder
Effects of estrogen on tissue Correct Answer ✅ maintain blood flow, the
collagen, and HA within the epithelial surfaces. Supports microbiome and
protects tissue from pathogens.
Vaginal changes with menopause Correct Answer ✅ Thinning, loss of
elasticity, loss or absence or rugae.
Vagina and urethra in menopause Correct Answer ✅ vagina narrows,
urethra moves closer to the introitus.
Stress urinary incontinence Correct Answer ✅ Vaginal estrogen and
urinary incontinence: what type does it help with?
pg. 3
