NAMS MENOPAUSE CERTIFICATION EXAM
1 2026 WITH QUESTIONS AND VERIFIED
ANSWERS GRADED A+
What part of the pituitary gland secretes adrenocorticotropic hormone?
Anterior pituitary. The posterior only secretes vasopressin and oxytosin.
Cortisol and HRT
Most serum cortisol circulates bound to cortisol binding globulin.
Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol concentration.
Do cortisol levels associate with VMS severity?
No, cortisol levels have NOT been associated with more severe VMS.
Local DHEA has been proven to help with what?
vaginal pain and dyspareunia
How to DX POI?
Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months.
,AND
elevated FSH over 25 on two occasions at least 4 weeks apart.
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
1 2026 WITH QUESTIONS AND VERIFIED
ANSWERS GRADED A+
What part of the pituitary gland secretes adrenocorticotropic hormone?
Anterior pituitary. The posterior only secretes vasopressin and oxytosin.
Cortisol and HRT
Most serum cortisol circulates bound to cortisol binding globulin.
Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol concentration.
Do cortisol levels associate with VMS severity?
No, cortisol levels have NOT been associated with more severe VMS.
Local DHEA has been proven to help with what?
vaginal pain and dyspareunia
How to DX POI?
Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months.
,AND
elevated FSH over 25 on two occasions at least 4 weeks apart.
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
