North_American_Menopause_Society_Menopa
use_Certification_Examination_Study_Guide
_2025_2026
1. Climacteric The period of endrocrinologic, somatic, and transitory psychologic changes that
phase occur around the time of menopause.
2. Early menopause LMP before age 45
3. Late menopause LMP after age 54
4. Primary ovarian Menopause that occurs before age 40
insu ciency
5. Early menopause Persistent di�erence of 7 days or more in the length of consecutive cycles.
transition (stage
-2)
6. Late menopause 60 or more consecutive days of amenorrhea
transition (stage
-1)
7. Luteal out of Explains why some perimenopausal women have elevated estrogen level some-
phase event times...In the early menopause transition, elevated FSH levels are adequate to
(LOOP) 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.
8. Obese women Obese women are more likely to have anovulatory cycles with high estradiol levels.
and estradiol They are also more likely to have lower premenopause yet higher postmenopause
levels during estradiol levels compared with women of normal weight. (why they are at higher
menopause risk of endometrial cancer)
9. Chinese and These ethnic groups have lower estradiol levels then white, black and hispanic
Japanese women women.
10. stage +2 late menopause stage: 5-8 years after FMP. Somatic aging predominates. In-
creased genitourinary symptoms.
,11. Stages +1a, +1b, early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS
+1c predominate.
12. Elevated FSH, LH Endocrine labs after menopause
13. AMH, inhibin B These hormones work during reproductive years to not deplete follicle pool too
quickly.
14. Phases during Menstrual cycle variable, persistent >7 day di�erence between di�erence in
menopause tran- length of consecutive cycles.
sition and PMS
symptoms
15. How to respond many pitfalls, variable depending on the day of the cycle you draw the lab, normal
if a patient re- or low FSH is not helpful.
quests FSH lab?
16. The potentially AMH
superior marker
of menopause, a
lab.
17. DHEA Adrenal androgens: precursor hromones produced by the adrenal gland that are
(dehy- enzymatically converted to active androgens or estrogens in peripheral tissues.
droepiandros-
terone)
18. Location of estro- Vagina, vulva, urethra, trigone of the bladder
gen receptors
19. E ects of estro- maintain blood ow, the collagen, and HA within the epithelial surfaces. Supports
gen on tissue microbiome which supports acidity of vagina and protects tissue from pathogens.
,20. Vaginal changes Thinning, loss of elasticity, loss or absence or rugae.
with menopause
21. Vagina and vagina narrows, urethra moves closer to the introitus.
urethra in
menopause
22. Stress urinary in- Vaginal estrogen and urinary incontinence: what type does it help with?
continence
23. Treatment for Minoxidil, spironolactone, nasteride, estrogen therapy
FPHL
24. Late reporoduc- -3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low.
tive years -3b
and -3a. What -3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low.
happens with
menstrual cycles,
FSH, AMH, AFC,
inhibin?
25. When it is appro- Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH
priate to check level.
an FSH during
the cycle if you
check it? and
why?
26. AMH produced by granulosa cells
produced by...
used to test... used to test damage to ovarian follicle reserve. If AMH is low, the woman has a
Is it a screening low ovarian reserve.
tool for fertility?
not recommended as a screening tool to predict fertility.
, When does it
peak? Peaks at around 25 years old. So before age 25, this test is not helpful.
It is in uenced by exogenous hormones. Lower in hormonal contraception users,
but increases after d/cing.
27. 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
follicles.
28. Late menopause 25 or higher
transition (-1)
FSH level on ran-
dom draw
29. Black women Higher
have higher or
lower FSH levels?
30. Chinese and lower
Japanese women
have higher or
lower estradi-
ol levels com-
pared to white,
black and hispan-
ic women?
31. Menopause tran- SHBG decreases
sition-changes in Testosterone/SHBG ratio increases by 80%.
SHBG and testos-
terone? ratio?
use_Certification_Examination_Study_Guide
_2025_2026
1. Climacteric The period of endrocrinologic, somatic, and transitory psychologic changes that
phase occur around the time of menopause.
2. Early menopause LMP before age 45
3. Late menopause LMP after age 54
4. Primary ovarian Menopause that occurs before age 40
insu ciency
5. Early menopause Persistent di�erence of 7 days or more in the length of consecutive cycles.
transition (stage
-2)
6. Late menopause 60 or more consecutive days of amenorrhea
transition (stage
-1)
7. Luteal out of Explains why some perimenopausal women have elevated estrogen level some-
phase event times...In the early menopause transition, elevated FSH levels are adequate to
(LOOP) 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.
8. Obese women Obese women are more likely to have anovulatory cycles with high estradiol levels.
and estradiol They are also more likely to have lower premenopause yet higher postmenopause
levels during estradiol levels compared with women of normal weight. (why they are at higher
menopause risk of endometrial cancer)
9. Chinese and These ethnic groups have lower estradiol levels then white, black and hispanic
Japanese women women.
10. stage +2 late menopause stage: 5-8 years after FMP. Somatic aging predominates. In-
creased genitourinary symptoms.
,11. Stages +1a, +1b, early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS
+1c predominate.
12. Elevated FSH, LH Endocrine labs after menopause
13. AMH, inhibin B These hormones work during reproductive years to not deplete follicle pool too
quickly.
14. Phases during Menstrual cycle variable, persistent >7 day di�erence between di�erence in
menopause tran- length of consecutive cycles.
sition and PMS
symptoms
15. How to respond many pitfalls, variable depending on the day of the cycle you draw the lab, normal
if a patient re- or low FSH is not helpful.
quests FSH lab?
16. The potentially AMH
superior marker
of menopause, a
lab.
17. DHEA Adrenal androgens: precursor hromones produced by the adrenal gland that are
(dehy- enzymatically converted to active androgens or estrogens in peripheral tissues.
droepiandros-
terone)
18. Location of estro- Vagina, vulva, urethra, trigone of the bladder
gen receptors
19. E ects of estro- maintain blood ow, the collagen, and HA within the epithelial surfaces. Supports
gen on tissue microbiome which supports acidity of vagina and protects tissue from pathogens.
,20. Vaginal changes Thinning, loss of elasticity, loss or absence or rugae.
with menopause
21. Vagina and vagina narrows, urethra moves closer to the introitus.
urethra in
menopause
22. Stress urinary in- Vaginal estrogen and urinary incontinence: what type does it help with?
continence
23. Treatment for Minoxidil, spironolactone, nasteride, estrogen therapy
FPHL
24. Late reporoduc- -3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low.
tive years -3b
and -3a. What -3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low.
happens with
menstrual cycles,
FSH, AMH, AFC,
inhibin?
25. When it is appro- Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH
priate to check level.
an FSH during
the cycle if you
check it? and
why?
26. AMH produced by granulosa cells
produced by...
used to test... used to test damage to ovarian follicle reserve. If AMH is low, the woman has a
Is it a screening low ovarian reserve.
tool for fertility?
not recommended as a screening tool to predict fertility.
, When does it
peak? Peaks at around 25 years old. So before age 25, this test is not helpful.
It is in uenced by exogenous hormones. Lower in hormonal contraception users,
but increases after d/cing.
27. 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
follicles.
28. Late menopause 25 or higher
transition (-1)
FSH level on ran-
dom draw
29. Black women Higher
have higher or
lower FSH levels?
30. Chinese and lower
Japanese women
have higher or
lower estradi-
ol levels com-
pared to white,
black and hispan-
ic women?
31. Menopause tran- SHBG decreases
sition-changes in Testosterone/SHBG ratio increases by 80%.
SHBG and testos-
terone? ratio?
