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NAMs Menopause Certification Exam
Questions and Correct Answers
Climacteric phase Ans: — The period of endrocrinologic, somatic,
and transitory psychologic changes that occur around the time of
menopause.
Early menopause Ans: — LMP before age 45
Late menopause Ans: — LMP after age 54
Primary ovarian insufficiency Ans: — Menopause that occurs
before age 40
Early menopause transition (stage -2) Ans: — Persistent difference
of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1) Ans: — 60 or more
consecutive days of amenorrhea
Luteal out of phase event (LOOP) Ans: — 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 Ans: —
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 Ans: — These ethnic groups have
lower estradiol levels then white, black and hispanic women.
stage +2 Ans: — late menopause stage: 5-8 years after FMP.
Somatic aging predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c Ans: — early post menopause: 2 years after
FMP. FSH rises, estradiol decreases. VMS predominate.
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Elevated FSH, LH Ans: — Endocrine labs after menopause
AMH, inhibin B Ans: — These hormones work during reproductive
years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms Ans: —
Menstrual cycle variable, persistent >7 day difference between
difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? Ans: — 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. Ans: — AMH
DHEA (dehydroepiandrosterone) Ans: — 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 Ans: — Vagina, vulva, urethra,
trigone of the bladder
Effects of estrogen on tissue Ans: — maintain blood flow, the
collagen, and HA within the epithelial surfaces. Supports
microbiome which supports acidity of vagina and protects tissue
from pathogens.
Vaginal changes with menopause Ans: — Thinning, loss of
elasticity, loss or absence or rugae.
Vagina and urethra in menopause Ans: — vagina narrows, urethra
moves closer to the introitus.
Stress urinary incontinence Ans: — Vaginal estrogen and urinary
incontinence: what type does it help with?
Treatment for FPHL Ans: — Minoxidil, spironolactone, finasteride,
estrogen therapy
Late reporoductive years -3b and -3a. What happens with
menstrual cycles, FSH, AMH, AFC, inhibin? Ans: — -3b: menstrual
cycles normal, FSH normal, AMH low, AFC low, inhibin low.
© 2025 All rights reserved
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-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? Ans: — Cycle 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? Ans: — 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.
AFC Ans: — Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the
availability pool of follicles.
© 2025 All rights reserved
NAMs Menopause Certification Exam
Questions and Correct Answers
Climacteric phase Ans: — The period of endrocrinologic, somatic,
and transitory psychologic changes that occur around the time of
menopause.
Early menopause Ans: — LMP before age 45
Late menopause Ans: — LMP after age 54
Primary ovarian insufficiency Ans: — Menopause that occurs
before age 40
Early menopause transition (stage -2) Ans: — Persistent difference
of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1) Ans: — 60 or more
consecutive days of amenorrhea
Luteal out of phase event (LOOP) Ans: — 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 Ans: —
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 Ans: — These ethnic groups have
lower estradiol levels then white, black and hispanic women.
stage +2 Ans: — late menopause stage: 5-8 years after FMP.
Somatic aging predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c Ans: — early post menopause: 2 years after
FMP. FSH rises, estradiol decreases. VMS predominate.
© 2025 All rights reserved
, 2 | Page
Elevated FSH, LH Ans: — Endocrine labs after menopause
AMH, inhibin B Ans: — These hormones work during reproductive
years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms Ans: —
Menstrual cycle variable, persistent >7 day difference between
difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? Ans: — 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. Ans: — AMH
DHEA (dehydroepiandrosterone) Ans: — 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 Ans: — Vagina, vulva, urethra,
trigone of the bladder
Effects of estrogen on tissue Ans: — maintain blood flow, the
collagen, and HA within the epithelial surfaces. Supports
microbiome which supports acidity of vagina and protects tissue
from pathogens.
Vaginal changes with menopause Ans: — Thinning, loss of
elasticity, loss or absence or rugae.
Vagina and urethra in menopause Ans: — vagina narrows, urethra
moves closer to the introitus.
Stress urinary incontinence Ans: — Vaginal estrogen and urinary
incontinence: what type does it help with?
Treatment for FPHL Ans: — Minoxidil, spironolactone, finasteride,
estrogen therapy
Late reporoductive years -3b and -3a. What happens with
menstrual cycles, FSH, AMH, AFC, inhibin? Ans: — -3b: menstrual
cycles normal, FSH normal, AMH low, AFC low, inhibin low.
© 2025 All rights reserved
, 3 | Page
-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? Ans: — Cycle 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? Ans: — 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.
AFC Ans: — Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the
availability pool of follicles.
© 2025 All rights reserved
