NAMS Menopause Certification Exam – Latest
2025/2026 Exam Prep & Practice Questions
Climacteric phase - correct answerThe period of endrocrinologic, 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 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 - correct answerObese 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 answerThese ethnic groups have lower
estradiol levels then white, black and hispanic women.
stage +2 - correct answerlate menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - correct answerearly post menopause: 2 years after FMP. FSH
rises, estradiol decreases. VMS predominate.
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 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? - correct answermany 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 answerAMH
DHEA (dehydroepiandrosterone) - correct answerAdrenal 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 answerVagina, vulva, urethra, trigone of the
bladder
Effects of estrogen on tissue - correct answermaintain blood flow, the collagen, and HA
within the epithelial surfaces. Supports microbiome and protects tissue from pathogens.
Vaginal changes with menopause - correct answerThinning, loss of elasticity, loss or
absence or 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 reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH,
AFC, inhibin? - 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? and why? -
correct answerCycle day #3. Elevated estradiol can suppress FSH giving a falsely
normal FSH level.
AMH
produced by...
used to test...
Is it a screening tool for fertility?
, When does it peak? - correct answerproduced 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.
Peaks at around 25 years old. So before age 25, this test is not helpful.
It is influenced by exogenous hormones. Lower in hormonal contraception users, but
increases after d/cing.
AFC - correct answerAntral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability poo of follicles.
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? ratio? - correct
answerSHBG decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB 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
therefore, follicle growth is not restrained, this allows for the growth of the remaining,
diminished follicle pool.
2025/2026 Exam Prep & Practice Questions
Climacteric phase - correct answerThe period of endrocrinologic, 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 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 - correct answerObese 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 answerThese ethnic groups have lower
estradiol levels then white, black and hispanic women.
stage +2 - correct answerlate menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - correct answerearly post menopause: 2 years after FMP. FSH
rises, estradiol decreases. VMS predominate.
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 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? - correct answermany 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 answerAMH
DHEA (dehydroepiandrosterone) - correct answerAdrenal 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 answerVagina, vulva, urethra, trigone of the
bladder
Effects of estrogen on tissue - correct answermaintain blood flow, the collagen, and HA
within the epithelial surfaces. Supports microbiome and protects tissue from pathogens.
Vaginal changes with menopause - correct answerThinning, loss of elasticity, loss or
absence or 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 reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH,
AFC, inhibin? - 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? and why? -
correct answerCycle day #3. Elevated estradiol can suppress FSH giving a falsely
normal FSH level.
AMH
produced by...
used to test...
Is it a screening tool for fertility?
, When does it peak? - correct answerproduced 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.
Peaks at around 25 years old. So before age 25, this test is not helpful.
It is influenced by exogenous hormones. Lower in hormonal contraception users, but
increases after d/cing.
AFC - correct answerAntral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability poo of follicles.
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? ratio? - correct
answerSHBG decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB 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
therefore, follicle growth is not restrained, this allows for the growth of the remaining,
diminished follicle pool.
