NAMS MENOPAUSE CERTIFICATION EXAM 2025/2026
QUESTIONS WITH ANSWERS GRADED A+
✔✔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
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 poo of follicles.
✔✔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 transition-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 higher 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 women 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 follicle 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 hormone
secreted by the anterior pituitary.
✔✔What part of the pituitary gland secretes adrenocorticotropic hormone? - ✔✔Anterior
pituitary. The posterior only secretes vasopressin and oxytosin.
✔✔Cortisol and HRT - ✔✔Most serum cortisol circulates bound to cortisol binding
globulin.
QUESTIONS WITH ANSWERS GRADED A+
✔✔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
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 poo of follicles.
✔✔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 transition-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 higher 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 women 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 follicle 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 hormone
secreted by the anterior pituitary.
✔✔What part of the pituitary gland secretes adrenocorticotropic hormone? - ✔✔Anterior
pituitary. The posterior only secretes vasopressin and oxytosin.
✔✔Cortisol and HRT - ✔✔Most serum cortisol circulates bound to cortisol binding
globulin.
