NAMS Menopause Certification Exam
Climacteric phase - ANS -The period of endocrinology, somatic, and transitory psychological
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
perimenopause yet higher postmenopausal 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 postmenopausal: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominates.
Elevated FSH, LH - ANS -Endocrine labs after menopause
AMH, inhibin B - ANS -These hormones work during reproductive years to not deplete the
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 hormones 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 reproductive 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.
-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.
Late menopause transition (-1) FSH level on random draw - ANS -25 or higher
Black women have higher or lower FSH levels? - ANS -Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and hispanic women? - ANS -lower
Menopause transition-changes in SHBG and testosterone? ratio? - ANS -SHBG decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what? - ANS -The free androgen index
What stage are VMS more likely? - ANS -+1b (generally last 2 years)
What hormone is generally higher in obese women? - ANS -Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones? - ANS -testosterone and
androstenedione
Surgical menopause causes women to have lower levels of what hormone? - ANS
-testosterone. 40-50% lower than in women w/ intact ovaries.
Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B and
AMH? - ANS -inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished
follicle pool.
In the menopause transition, women spend more time in what phase? - ANS -Luteal-more PMS
symptoms, more frequent menstrual periods.
Climacteric phase - ANS -The period of endocrinology, somatic, and transitory psychological
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
perimenopause yet higher postmenopausal 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 postmenopausal: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominates.
Elevated FSH, LH - ANS -Endocrine labs after menopause
AMH, inhibin B - ANS -These hormones work during reproductive years to not deplete the
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 hormones 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 reproductive 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.
-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.
Late menopause transition (-1) FSH level on random draw - ANS -25 or higher
Black women have higher or lower FSH levels? - ANS -Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and hispanic women? - ANS -lower
Menopause transition-changes in SHBG and testosterone? ratio? - ANS -SHBG decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what? - ANS -The free androgen index
What stage are VMS more likely? - ANS -+1b (generally last 2 years)
What hormone is generally higher in obese women? - ANS -Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones? - ANS -testosterone and
androstenedione
Surgical menopause causes women to have lower levels of what hormone? - ANS
-testosterone. 40-50% lower than in women w/ intact ovaries.
Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B and
AMH? - ANS -inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished
follicle pool.
In the menopause transition, women spend more time in what phase? - ANS -Luteal-more PMS
symptoms, more frequent menstrual periods.
