Verified Answers & Detailed Rationales | Comprehensive Exam Review Pack
This comprehensive exam review pack is designed to help healthcare
professionals master the essential concepts tested on the NAMS Menopause
Certification examination. It features original practice questions, accurate
answers, and detailed rationales that reinforce clinical reasoning and support
effective exam preparation
Climacteric phase - CORRECT ANSWER The period of
endrocrinologic, somatic, and transitory psychologic changes that
occur around the time of menopause.
QUESTION :Early menopause - CORRECT ANSWER LMP before age
45
QUESTION :Late menopause - CORRECT ANSWER LMP after age 54
QUESTION :Primary ovarian insufficiency - CORRECT ANSWER
Menopause that occurs before age 40
QUESTION :Early menopause transition (stage -2) - CORRECT
ANSWER Persistent difference of 7 days or more in the length of
consecutive cycles.
QUESTION :Late menopause transition (stage -1) - CORRECT ANSWER
60 or more consecutive days of amenorrhea
QUESTION :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.
, QUESTION :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)
QUESTION :Chinese and Japanese women - CORRECT ANSWER
These ethnic groups have lower estradiol levels then white, black and
hispanic women.
QUESTION :stage +2 - CORRECT ANSWER late menopause stage: 5-
8 years after FMP. Somatic aging predominates. Increased
genitourinary symptoms.
QUESTION :Stages +1a, +1b, +1c - CORRECT ANSWER early post
menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS
predominate.
QUESTION :Elevated FSH, LH - CORRECT ANSWER Endocrine labs
after menopause
QUESTION :AMH, inhibin B - CORRECT ANSWER These hormones
work during reproductive years to not deplete follicle pool too quickly.
QUESTION :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.
QUESTION :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.
QUESTION :The potentially superior marker of menopause, a lab. -
CORRECT ANSWER AMH
, QUESTION :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.
QUESTION :Location of estrogen receptors - CORRECT ANSWER
Vagina, vulva, urethra, trigone of the bladder
QUESTION :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.
QUESTION :Vaginal changes with menopause - CORRECT ANSWER
Thinning, loss of elasticity, loss or absence or rugae.
QUESTION :Vagina and urethra in menopause - CORRECT ANSWER
vagina narrows, urethra moves closer to the introitus.
QUESTION :Stress urinary incontinence - CORRECT ANSWER
Vaginal estrogen and urinary incontinence: what type does it help
with?
QUESTION :Treatment for FPHL - CORRECT ANSWER Minoxidil,
spironolactone, finasteride, estrogen therapy
QUESTION :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.
QUESTION :When it is appropriate to check an FSH during the cycle if
you check it? and why? - CORRECT ANSWER Cycle day #3. Elevated
estradiol can suppress FSH giving a falsely normal FSH level.
QUESTION :AMH
produced by...
, used to test...
Is it a screening tool for fertility?
When does it peak? - CORRECT ANSWER 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.
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.
QUESTION :AFC - CORRECT ANSWER Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability
poo of follicles.
QUESTION :Late menopause transition (-1) FSH level on random draw
- CORRECT ANSWER 25 or higher
QUESTION :Black women have higher or lower FSH levels? - CORRECT
ANSWER Higher
QUESTION :Chinese and Japanese women have higher or lower
estradiol levels compared to white, black and hispanic women? -
CORRECT ANSWER lower
QUESTION :Menopause transition-changes in SHBG and testosterone?
ratio? - CORRECT ANSWER SHBG decreases
Testosterone/SHBG ratio increases by 80%.
QUESTION :Testosterone/SHGB ratio is called what? - CORRECT
ANSWER The free androgen index