NAMS Menopause Certification Exam 2025
Climacteric phase
The period of endocrinology, somatic, and transitory psychological changes that occur around
the time of menopause.
Perimenopause Menopause Transition, Early
List the STRAW Stage
What defines the phase?
STRAW Stage: (Stage -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
Perimenopause Menopause Transition, Late
List the STRAW Stage
What defines the phase?
STRAW Stage: (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.
Describe the E2 level during the life of a patient with obesity.
They are also more likely to have lower premenopause/perimenopausal estradiol levels
compared to patients with average BMIs. However, the level is the highest in postmenopausal
patients with obesity.
In comparison to other ethnicities, Chinese and Japanese women have ___ E2 levels?
These ethnic groups have lower estradiol levels than white, black and hispanic women.
,STRAW Stage +2, describe the timeline as well as the predominant symptoms.
Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.
Stages +1a, +1b, +1c, describe the timeline as well as the supportive criteria and the symptoms.
Postmenopause, Early. 2 years after FMP.
+1a/b (2yrs) FSH variable where as the AMH and InhB are low. The AFC are very low. VMS
predominate.
1c (3-6yrs) FSH levels stabilize. The other measures continue as previous.
Elevated FSH, LH
Endocrine labs after menopause
AMH, Inhibin B
These hormones work during reproductive years to not deplete follicle pool too quickly.
Describe the phases during the early menopause transition and what happens with PMS
symptoms
Menstrual cycle shortens. Due to unrestrained FSH, follicular phase compresses. More
premenstrual symptoms due to the longer luteal phase. Cycle irregularity and skipped cycles
because of ovulatory failure and increased atresia.
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.
What lab is potentially the superior marker of time to menopause?
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 GU estrogen receptors (4)
Vagina, vulva, urethra, trigone of the bladder
, List the effects of estrogen on tissue (4+2)
1 ) maintains blood flow to tissue, maintains the collagen within the epithelium, and maintains
the hyaluronic acid and mucopolysaccharides within the moistened epithelial surface, maintains
pH (4.5) 2) supports microbiome and protects tissue from pathogens
List the vaginal changes with menopause you might note on clinical/microscopic exam.
Thinning of the epithelial layer, loss of elasticity with narrowing of the canal and poor distention,
noted on pelvic exam with loss or absence or rugae. Due to the decrease in glycogen content,
the lactobacilli are decreased resulting in higher pH.
List the vulvar and urethral changes in menopause.
Thinning of the epithelial layers and vagina narrowing leads the urethra to move closer to the
introitus.
Stress urinary incontinence
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 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?
produced by granulosa cells
Climacteric phase
The period of endocrinology, somatic, and transitory psychological changes that occur around
the time of menopause.
Perimenopause Menopause Transition, Early
List the STRAW Stage
What defines the phase?
STRAW Stage: (Stage -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
Perimenopause Menopause Transition, Late
List the STRAW Stage
What defines the phase?
STRAW Stage: (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.
Describe the E2 level during the life of a patient with obesity.
They are also more likely to have lower premenopause/perimenopausal estradiol levels
compared to patients with average BMIs. However, the level is the highest in postmenopausal
patients with obesity.
In comparison to other ethnicities, Chinese and Japanese women have ___ E2 levels?
These ethnic groups have lower estradiol levels than white, black and hispanic women.
,STRAW Stage +2, describe the timeline as well as the predominant symptoms.
Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.
Stages +1a, +1b, +1c, describe the timeline as well as the supportive criteria and the symptoms.
Postmenopause, Early. 2 years after FMP.
+1a/b (2yrs) FSH variable where as the AMH and InhB are low. The AFC are very low. VMS
predominate.
1c (3-6yrs) FSH levels stabilize. The other measures continue as previous.
Elevated FSH, LH
Endocrine labs after menopause
AMH, Inhibin B
These hormones work during reproductive years to not deplete follicle pool too quickly.
Describe the phases during the early menopause transition and what happens with PMS
symptoms
Menstrual cycle shortens. Due to unrestrained FSH, follicular phase compresses. More
premenstrual symptoms due to the longer luteal phase. Cycle irregularity and skipped cycles
because of ovulatory failure and increased atresia.
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.
What lab is potentially the superior marker of time to menopause?
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 GU estrogen receptors (4)
Vagina, vulva, urethra, trigone of the bladder
, List the effects of estrogen on tissue (4+2)
1 ) maintains blood flow to tissue, maintains the collagen within the epithelium, and maintains
the hyaluronic acid and mucopolysaccharides within the moistened epithelial surface, maintains
pH (4.5) 2) supports microbiome and protects tissue from pathogens
List the vaginal changes with menopause you might note on clinical/microscopic exam.
Thinning of the epithelial layer, loss of elasticity with narrowing of the canal and poor distention,
noted on pelvic exam with loss or absence or rugae. Due to the decrease in glycogen content,
the lactobacilli are decreased resulting in higher pH.
List the vulvar and urethral changes in menopause.
Thinning of the epithelial layers and vagina narrowing leads the urethra to move closer to the
introitus.
Stress urinary incontinence
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 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?
produced by granulosa cells
