2024 NAMS MENOPAUSE CERTIFICATION EXAM QUESTIONS WITH ANSWERS

2024 NAMS MENOPAUSE CERTIFICATION EXAM QUESTIONS WITH ANSWERS Climacteric phase The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of menopause. Early meno pause 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 adequ ate 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 Jap anese 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 AMH, inhibin B These hormones work during reproductive years to not deplete follicle pool too quickly. Phases during menopause transition and PMS symptoms Menstrual cycle variable, persistent >7 day difference between difference in length of consecutive cycles. How to respond if a patient requests FSH lab? 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. AMH DHEA (dehydroepiandrosterone) 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 Vagina, vulva, urethra, trigone of the bladder Effects of estrogen on tissue maintain blood flow, the collagen, and HA within the epithelial surfaces. Supports microbiome which s upports acidity of vagina and protects tissue from pathogens. Vaginal changes with menopause Thinning, loss of elasticity, loss or absence or rugae. Vagina and urethra in menopause vagina narrows, urethra moves closer to the introitus. Stress urinary incon tinence Vaginal estrogen and urinary incontinence: what type does it help with? Treatment for FPHL Minoxidil, spironolactone, finasteride, estrogen therapy Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? -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? Cycle day #3. Elevated est radiol 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? 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 Antral follicle count Number of follicles that are detectable with ultrasound. They are sensitive to FSH and considered to represent the availability pool of follicl es. Late menopause transition ( -1) FSH level on random draw 25 or higher Black women have higher or lower FSH levels? Higher Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic women? lower Menopause trans ition -changes in SHBG and testosterone? ratio? SHBG decreases Testosterone/SHBG ratio increases by 80%. Testosterone/SHGB ratio is called what? The free androgen index What stage are VMS more likely? +1b (generally last 2 years) What hormone is generally h igher in obese women? Estrone -via aromatization. The postmenopausal ovary continues to produce what two hormones? testosterone and androstenedione Surgical menopause causes women to have lower levels of what hormone? testosterone. 40 -50% lower than in wome n w/ intact ovaries. Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B and AMH? inhibin and AMH decrease therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished foll icle pool. In the menopause transition, women spend more time in what phase? Luteal -more PMS symptoms, more frequent menstrual periods. HPO axis theory and the menopause transition It is felt that the HPO axis may become less sensitive to estrogen, so even with good follicle growth and estradiol secretion, LH surges can fail which can lead to more cycle irregularity. In the first year after the FMP, there is no production of what hormone? progesterone What region of the adrenal gland secretes the androgens? zona reticularis what are considered the 'adrenal androgens'? DHEA, DHEAS, Androstenedione. Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors. Angiotensin II, potassium concentration, adrenocorticotropic h ormone secreted by the anterior pituitary.