NAMS MENOPAUSE CERTIFICATION
REVIEW SOLVED QUESTIONS WITH
COMPLETE SOLUTION
●● Early menopause
Answer: LMP before age 45.
●● Late menopause
Answer: LMP after age 54.
●● Primary ovarian insufficiency
Answer: Menopause that occurs before age 40.
●● Early menopause transition (stage -2)
Answer: Persistent difference of 7 days or more in the length of
consecutive cycles.
●● Late menopause transition (stage -1)
Answer: 60 or more consecutive days of amenorrhea.
●● Luteal out of phase event (LOOP)
,Answer: Explains why some perimenopausal women have elevated
estrogen levels sometimes.
●● Obese women and estradiol levels during menopause
Answer: Obese women are more likely to have anovulatory cycles with
high estradiol levels.
●● Chinese and Japanese women
Answer: These ethnic groups have lower estradiol levels than white,
black, and Hispanic women.
●● Stage +2
Answer: Late menopause stage: 5-8 years after FMP. Somatic aging
predominates.
●● Stages +1a, +1b, +1c
Answer: Early post menopause: 2 years after FMP. FSH rises, estradiol
decreases.
●● Elevated FSH, LH
Answer: Endocrine labs after menopause.
●● AMH, inhibin B
,Answer: These hormones work during reproductive years to not deplete
follicle pool too quickly.
●● Phases during menopause transition and PMS symptoms
Answer: Menstrual cycle variable, persistent >7 day difference between
difference in length of consecutive cycles.
●● How to respond if a patient requests FSH lab?
Answer: Many pitfalls, variable depending on the day of the cycle you
draw the lab.
●● The potentially superior marker of menopause, a lab.
Answer: AMH.
●● DHEA (dehydroepiandrosterone)
Answer: Adrenal androgens: precursor hormones produced by the
adrenal gland that are enzymatically converted to active androgens or
estrogens in peripheral tissues.
●● Location of estrogen receptors
Answer: Vagina, vulva, urethra, trigone of the bladder.
●● Effects of estrogen on tissue
, Answer: Maintain blood flow, the collagen, and HA within the epithelial
surfaces.
●● Vaginal changes with menopause
Answer: Thinning, loss of elasticity, loss or absence of rugae.
●● Vagina and urethra in menopause
Answer: Vagina narrows, urethra moves closer to the introitus.
●● Stress urinary incontinence
Answer: Vaginal estrogen and urinary incontinence: what type does it
help with?
●● Treatment for FPHL
Answer: Minoxidil, spironolactone, finasteride, estrogen therapy.
●● Late reproductive years -3b and -3a
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?
REVIEW SOLVED QUESTIONS WITH
COMPLETE SOLUTION
●● Early menopause
Answer: LMP before age 45.
●● Late menopause
Answer: LMP after age 54.
●● Primary ovarian insufficiency
Answer: Menopause that occurs before age 40.
●● Early menopause transition (stage -2)
Answer: Persistent difference of 7 days or more in the length of
consecutive cycles.
●● Late menopause transition (stage -1)
Answer: 60 or more consecutive days of amenorrhea.
●● Luteal out of phase event (LOOP)
,Answer: Explains why some perimenopausal women have elevated
estrogen levels sometimes.
●● Obese women and estradiol levels during menopause
Answer: Obese women are more likely to have anovulatory cycles with
high estradiol levels.
●● Chinese and Japanese women
Answer: These ethnic groups have lower estradiol levels than white,
black, and Hispanic women.
●● Stage +2
Answer: Late menopause stage: 5-8 years after FMP. Somatic aging
predominates.
●● Stages +1a, +1b, +1c
Answer: Early post menopause: 2 years after FMP. FSH rises, estradiol
decreases.
●● Elevated FSH, LH
Answer: Endocrine labs after menopause.
●● AMH, inhibin B
,Answer: These hormones work during reproductive years to not deplete
follicle pool too quickly.
●● Phases during menopause transition and PMS symptoms
Answer: Menstrual cycle variable, persistent >7 day difference between
difference in length of consecutive cycles.
●● How to respond if a patient requests FSH lab?
Answer: Many pitfalls, variable depending on the day of the cycle you
draw the lab.
●● The potentially superior marker of menopause, a lab.
Answer: AMH.
●● DHEA (dehydroepiandrosterone)
Answer: Adrenal androgens: precursor hormones produced by the
adrenal gland that are enzymatically converted to active androgens or
estrogens in peripheral tissues.
●● Location of estrogen receptors
Answer: Vagina, vulva, urethra, trigone of the bladder.
●● Effects of estrogen on tissue
, Answer: Maintain blood flow, the collagen, and HA within the epithelial
surfaces.
●● Vaginal changes with menopause
Answer: Thinning, loss of elasticity, loss or absence of rugae.
●● Vagina and urethra in menopause
Answer: Vagina narrows, urethra moves closer to the introitus.
●● Stress urinary incontinence
Answer: Vaginal estrogen and urinary incontinence: what type does it
help with?
●● Treatment for FPHL
Answer: Minoxidil, spironolactone, finasteride, estrogen therapy.
●● Late reproductive years -3b and -3a
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?
