NAMS MENOPAUSE CERTIFICATION
EXAM
2025/2026
Verified Questions and Answers
A+ Grades Guarantee
, The period of endrocrinologic, somatic, and transitory psychologic
Climacteric phase changes that occur around the time of menopause.
Early menopause LMP before age 45
Late menopause LMP after age 54
Primary ovarian insufficiency Menopause that occurs before age 40
Early menopause transition (stage Persistent difference of 7 days or more in the length of consecutive
-2) cycles.
60 or more consecutive days of amenorrhea
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
Luteal out of phase event (LOOP) phase of the ongoing ovulatory cycle.
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
Obese women and estradiol levels normal weight. (why they are at higher risk of endometrial cancer)
during menopause
These ethnic groups have lower estradiol levels then white, black and
Chinese and Japanese women hispanic women.
late menopause stage: 5-8 years after FMP. Somatic aging predominates.
stage +2 Increased genitourinary symptoms.
early post menopause: 2 years after FMP. FSH rises, estradiol decreases.
Stages +1a, +1b, +1c VMS predominate.
Elevated FSH, LH Endocrine labs after menopause
These hormones work during reproductive years to not deplete follicle
AMH, inhibin B pool too quickly.
Phases during menopause transition Menstrual cycle variable, persistent >7 day difference between difference
and PMS symptoms in length of consecutive cycles.
How to respond if a patient requests many pitfalls, variable depending on the day of the cycle you draw the
FSH lab? lab, normal or low FSH is not helpful.
The potentially superior marker of AMH
menopause, a lab.
Adrenal androgens: precursor hromones produced by the adrenal gland
that are enzymatically converted to active androgens or estrogens in
DHEA (dehydroepiandrosterone) peripheral tissues.
Location of estrogen receptors Vagina, vulva, urethra, trigone of the bladder
, maintain blood flow, the collagen, and HA within the epithelial surfaces.
Supports microbiome which supports acidity of vagina and protects tissue
Effects of estrogen on tissue from pathogens.
Thinning, loss of elasticity, loss or absence or rugae.
Vaginal changes with menopause
vagina narrows, urethra moves closer to the introitus.
Vagina and urethra in menopause
Vaginal estrogen and urinary incontinence: what type does it help with?
Stress urinary incontinence
Treatment for FPHL Minoxidil, spironolactone, finasteride, estrogen therapy
-3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin
low.
Late reporoductive years -3b and
-3a. What happens with menstrual -3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin
cycles, FSH, AMH, AFC, inhibin? low.
Cycle day #3. Elevated estradiol can suppress FSH giving a falsely
When it is appropriate to check an normal FSH level.
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.
AMH
produced by... Peaks at around 25 years old. So before age 25, this test is not helpful.
used to test...
Is it a screening tool for fertility? It is influenced by exogenous hormones. Lower in hormonal
When does it peak? contraception users, but increases after d/cing.
Antral follicle count
Number of follicles that are detectable with ultrasound.
AFC They are sensitive to FSH and considered to represent the availability
pool of follicles.
Late menopause transition (-1) FSH 25 or higher
level on random draw
Black women have higher or lower Higher
FSH levels?
lower
Chinese and Japanese women have
higher or lower estradiol levels
compared to white, black and
hispanic women?
EXAM
2025/2026
Verified Questions and Answers
A+ Grades Guarantee
, The period of endrocrinologic, somatic, and transitory psychologic
Climacteric phase changes that occur around the time of menopause.
Early menopause LMP before age 45
Late menopause LMP after age 54
Primary ovarian insufficiency Menopause that occurs before age 40
Early menopause transition (stage Persistent difference of 7 days or more in the length of consecutive
-2) cycles.
60 or more consecutive days of amenorrhea
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
Luteal out of phase event (LOOP) phase of the ongoing ovulatory cycle.
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
Obese women and estradiol levels normal weight. (why they are at higher risk of endometrial cancer)
during menopause
These ethnic groups have lower estradiol levels then white, black and
Chinese and Japanese women hispanic women.
late menopause stage: 5-8 years after FMP. Somatic aging predominates.
stage +2 Increased genitourinary symptoms.
early post menopause: 2 years after FMP. FSH rises, estradiol decreases.
Stages +1a, +1b, +1c VMS predominate.
Elevated FSH, LH Endocrine labs after menopause
These hormones work during reproductive years to not deplete follicle
AMH, inhibin B pool too quickly.
Phases during menopause transition Menstrual cycle variable, persistent >7 day difference between difference
and PMS symptoms in length of consecutive cycles.
How to respond if a patient requests many pitfalls, variable depending on the day of the cycle you draw the
FSH lab? lab, normal or low FSH is not helpful.
The potentially superior marker of AMH
menopause, a lab.
Adrenal androgens: precursor hromones produced by the adrenal gland
that are enzymatically converted to active androgens or estrogens in
DHEA (dehydroepiandrosterone) peripheral tissues.
Location of estrogen receptors Vagina, vulva, urethra, trigone of the bladder
, maintain blood flow, the collagen, and HA within the epithelial surfaces.
Supports microbiome which supports acidity of vagina and protects tissue
Effects of estrogen on tissue from pathogens.
Thinning, loss of elasticity, loss or absence or rugae.
Vaginal changes with menopause
vagina narrows, urethra moves closer to the introitus.
Vagina and urethra in menopause
Vaginal estrogen and urinary incontinence: what type does it help with?
Stress urinary incontinence
Treatment for FPHL Minoxidil, spironolactone, finasteride, estrogen therapy
-3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin
low.
Late reporoductive years -3b and
-3a. What happens with menstrual -3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin
cycles, FSH, AMH, AFC, inhibin? low.
Cycle day #3. Elevated estradiol can suppress FSH giving a falsely
When it is appropriate to check an normal FSH level.
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.
AMH
produced by... Peaks at around 25 years old. So before age 25, this test is not helpful.
used to test...
Is it a screening tool for fertility? It is influenced by exogenous hormones. Lower in hormonal
When does it peak? contraception users, but increases after d/cing.
Antral follicle count
Number of follicles that are detectable with ultrasound.
AFC They are sensitive to FSH and considered to represent the availability
pool of follicles.
Late menopause transition (-1) FSH 25 or higher
level on random draw
Black women have higher or lower Higher
FSH levels?
lower
Chinese and Japanese women have
higher or lower estradiol levels
compared to white, black and
hispanic women?
