NAMs Menopause Certification Exam
2025-2026
Climacteric phase - correct answerThe period of endocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause - correct answerLMP before age 45.
Late menopause - correct answerLMP after age 54.
Primary ovarian insufficiency - correct answerMenopause that occurs before age 40.
Early menopause transition (stage -2) - correct answerPersistent difference of 7 days or
more in the length of consecutive cycles.
Late menopause transition (stage -1) - correct answer60 or more consecutive days of
amenorrhea.
Luteal out of phase event (LOOP) - correct answerExplains why some perimenopausal
women have elevated estrogen levels sometimes.
Obese women and estradiol levels during menopause - correct answerObese women
are more likely to have anovulatory cycles with high estradiol levels.
Chinese and Japanese women - correct answerThese ethnic groups have lower
estradiol levels than white, black, and Hispanic women.
Stage +2 - correct answerLate menopause stage: 5-8 years after FMP. Somatic aging
predominates.
Stages +1a, +1b, +1c - correct answerEarly post menopause: 2 years after FMP. FSH
rises, estradiol decreases.
Elevated FSH, LH - correct answerEndocrine labs after menopause.
AMH, inhibin B - correct answerThese hormones work during reproductive years to not
deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms - correct answerMenstrual
cycle variable, persistent >7 day difference between difference in length of consecutive
cycles.
,How to respond if a patient requests FSH lab? - correct answerMany pitfalls, variable
depending on the day of the cycle you draw the lab.
The potentially superior marker of menopause, a lab. - correct answerAMH.
DHEA (dehydroepiandrosterone) - correct answerAdrenal androgens: precursor
hormones produced by the adrenal gland that are enzymatically converted to active
androgens or estrogens in peripheral tissues.
Location of estrogen receptors - correct answerVagina, vulva, urethra, trigone of the
bladder.
Effects of estrogen on tissue - correct answerMaintain blood flow, the collagen, and HA
within the epithelial surfaces.
Vaginal changes with menopause - correct answerThinning, loss of elasticity, loss or
absence of rugae.
Vagina and urethra in menopause - correct answerVagina narrows, urethra moves
closer to the introitus.
Stress urinary incontinence - correct answerVaginal estrogen and urinary incontinence:
what type does it help with?
Treatment for FPHL - correct answerMinoxidil, spironolactone, finasteride, estrogen
therapy.
Late reproductive years -3b and -3a - correct 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? - correct
answerCycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH
level.
AFC - correct answerAntral follicle count. Number of follicles that are detectable with
ultrasound.
Late menopause transition (-1) FSH level on random draw - correct answer25 or higher.
Black women have higher or lower FSH levels? - correct answerHigher.
Chinese and Japanese women have higher or lower estradiol levels compared to white,
black and Hispanic women? - correct answerLower.
, Menopause transition-changes in SHBG and testosterone? - correct answerSHBG
decreases. Testosterone/SHBG ratio increases by 80%.
Testosterone/SHBG ratio is called what? - correct answerThe free androgen index.
What stage are VMS more likely? - correct answer+1b (generally last 2 years).
What hormone is generally higher in obese women? - correct answerEstrone-via
aromatization.
The postmenopausal ovary continues to produce what two hormones? - correct
answerTestosterone and androstenedione.
Surgical menopause causes women to have lower levels of what hormone? - correct
answerTestosterone. 40-50% lower than in women w/ intact ovaries.
Driving piece of menopause is ovarian follicles depleting. What does this do to the
inhibin B and AMH? - correct answerInhibin and AMH decrease.
In the menopause transition, women spend more time in what phase? - correct
answerLuteal-more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition - correct answerIt is felt that the HPO
axis may become less sensitive to estrogen.
In the first year after the FMP, there is no production of what hormone? - correct
answerProgesterone.
What region of the adrenal gland secretes the androgens? - correct answerZona
reticularis.
What are considered the 'adrenal androgens'? - correct answerDHEA, DHEAS,
Androstenedione.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3
main factors. - correct answerAngiotensin II, potassium concentration,
adrenocorticotropic hormone secreted by the anterior pituitary.
What part of the pituitary gland secretes adrenocorticotropic hormone? - correct
answerAnterior pituitary.
Cortisol and HRT - correct answerMost serum cortisol circulates bound to cortisol
binding globulin.
Do cortisol levels associate with VMS severity? - correct answerNo, cortisol levels have
NOT been associated with more severe VMS.
2025-2026
Climacteric phase - correct answerThe period of endocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause - correct answerLMP before age 45.
Late menopause - correct answerLMP after age 54.
Primary ovarian insufficiency - correct answerMenopause that occurs before age 40.
Early menopause transition (stage -2) - correct answerPersistent difference of 7 days or
more in the length of consecutive cycles.
Late menopause transition (stage -1) - correct answer60 or more consecutive days of
amenorrhea.
Luteal out of phase event (LOOP) - correct answerExplains why some perimenopausal
women have elevated estrogen levels sometimes.
Obese women and estradiol levels during menopause - correct answerObese women
are more likely to have anovulatory cycles with high estradiol levels.
Chinese and Japanese women - correct answerThese ethnic groups have lower
estradiol levels than white, black, and Hispanic women.
Stage +2 - correct answerLate menopause stage: 5-8 years after FMP. Somatic aging
predominates.
Stages +1a, +1b, +1c - correct answerEarly post menopause: 2 years after FMP. FSH
rises, estradiol decreases.
Elevated FSH, LH - correct answerEndocrine labs after menopause.
AMH, inhibin B - correct answerThese hormones work during reproductive years to not
deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms - correct answerMenstrual
cycle variable, persistent >7 day difference between difference in length of consecutive
cycles.
,How to respond if a patient requests FSH lab? - correct answerMany pitfalls, variable
depending on the day of the cycle you draw the lab.
The potentially superior marker of menopause, a lab. - correct answerAMH.
DHEA (dehydroepiandrosterone) - correct answerAdrenal androgens: precursor
hormones produced by the adrenal gland that are enzymatically converted to active
androgens or estrogens in peripheral tissues.
Location of estrogen receptors - correct answerVagina, vulva, urethra, trigone of the
bladder.
Effects of estrogen on tissue - correct answerMaintain blood flow, the collagen, and HA
within the epithelial surfaces.
Vaginal changes with menopause - correct answerThinning, loss of elasticity, loss or
absence of rugae.
Vagina and urethra in menopause - correct answerVagina narrows, urethra moves
closer to the introitus.
Stress urinary incontinence - correct answerVaginal estrogen and urinary incontinence:
what type does it help with?
Treatment for FPHL - correct answerMinoxidil, spironolactone, finasteride, estrogen
therapy.
Late reproductive years -3b and -3a - correct 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? - correct
answerCycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH
level.
AFC - correct answerAntral follicle count. Number of follicles that are detectable with
ultrasound.
Late menopause transition (-1) FSH level on random draw - correct answer25 or higher.
Black women have higher or lower FSH levels? - correct answerHigher.
Chinese and Japanese women have higher or lower estradiol levels compared to white,
black and Hispanic women? - correct answerLower.
, Menopause transition-changes in SHBG and testosterone? - correct answerSHBG
decreases. Testosterone/SHBG ratio increases by 80%.
Testosterone/SHBG ratio is called what? - correct answerThe free androgen index.
What stage are VMS more likely? - correct answer+1b (generally last 2 years).
What hormone is generally higher in obese women? - correct answerEstrone-via
aromatization.
The postmenopausal ovary continues to produce what two hormones? - correct
answerTestosterone and androstenedione.
Surgical menopause causes women to have lower levels of what hormone? - correct
answerTestosterone. 40-50% lower than in women w/ intact ovaries.
Driving piece of menopause is ovarian follicles depleting. What does this do to the
inhibin B and AMH? - correct answerInhibin and AMH decrease.
In the menopause transition, women spend more time in what phase? - correct
answerLuteal-more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition - correct answerIt is felt that the HPO
axis may become less sensitive to estrogen.
In the first year after the FMP, there is no production of what hormone? - correct
answerProgesterone.
What region of the adrenal gland secretes the androgens? - correct answerZona
reticularis.
What are considered the 'adrenal androgens'? - correct answerDHEA, DHEAS,
Androstenedione.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3
main factors. - correct answerAngiotensin II, potassium concentration,
adrenocorticotropic hormone secreted by the anterior pituitary.
What part of the pituitary gland secretes adrenocorticotropic hormone? - correct
answerAnterior pituitary.
Cortisol and HRT - correct answerMost serum cortisol circulates bound to cortisol
binding globulin.
Do cortisol levels associate with VMS severity? - correct answerNo, cortisol levels have
NOT been associated with more severe VMS.
