NAMS MENOPAUSE CERTIFICATION EXAM
QUESTIONS AND VERIFIED SOLUTIONS
GRADED A+ 100% PASS
Climacteric phase
The period of endrocrinologic, somatic, and transitory psychologic 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 -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1)
60 or more consecutive days of amenorrhea
,Luteal out of phase event (LOOP)
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
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
These ethnic groups have lower estradiol levels then white, black and hispanic women.
stage +2
late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary
symptoms.
Stages +1a, +1b, +1c
early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate.
Elevated FSH, LH
Endocrine labs after menopause
, AMH, inhibin B
These hormones work during reproductive years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms
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?
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.
AMH
DHEA (dehydroepiandrosterone)
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
Vagina, vulva, urethra, trigone of the bladder
QUESTIONS AND VERIFIED SOLUTIONS
GRADED A+ 100% PASS
Climacteric phase
The period of endrocrinologic, somatic, and transitory psychologic 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 -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1)
60 or more consecutive days of amenorrhea
,Luteal out of phase event (LOOP)
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
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
These ethnic groups have lower estradiol levels then white, black and hispanic women.
stage +2
late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary
symptoms.
Stages +1a, +1b, +1c
early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate.
Elevated FSH, LH
Endocrine labs after menopause
, AMH, inhibin B
These hormones work during reproductive years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms
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?
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.
AMH
DHEA (dehydroepiandrosterone)
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
Vagina, vulva, urethra, trigone of the bladder
