NAMS MENOPAUSE CERTIFICATION PRACTICE EXAM 2025/2026
QUESTIONS WITH ANSWERS GRADED A+
✔✔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 and contribute to cycle irregularity.
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.
Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol
concentration.
,✔✔Do cortisol levels associate with VMS severity? - ✔✔No, cortisol levels have NOT
been associated with more severe VMS.
✔✔Local DHEA has been proven to help with what? - ✔✔vaginal pain and dyspareunia
✔✔How to DX POI? - ✔✔(Cannot use standard dx criterion for meno)
1. Presence of menstrual disturbance like oligomenorrhea (infrequent cycles) or
amenorrhea for at least 4 months.
AND
2. elevated FSH level over 25 IU/L on two occasions at least 4 weeks apart.
✔✔Anyone <40years old who misses 3+ consecutive cycles gets these labs -
✔✔prolactin
FSH
estradiol
TSH
pregnancy test
✔✔treatment of POI - ✔✔Hormone Therapy for POI:
100 microgram estradiol patch OR
1.25 mg Conjugated equine estrogens OR
2mg oral estradiol
If intact uterus-progesterone for 12 days of the month.
Physiologic HT is better than continuous hormonal contraception, but if menorrhagia-
IUD plus estrogen patch, or if really not wanting to risk pregnancy, continuous HRT can
be used.
Length: Until the average age of natural menopause
✔✔Hair loss. Difference between FPHL and telogen effluvium? - ✔✔FPHL is gradual,
telogen effluvium is sudden and usually precipitated by a life stressor, chronic illness,
beta blockers or anticoagulants-usually more patchy hair loss.
✔✔FPHL pattern - ✔✔thinning at the crown of the head and widening of the hair part
✔✔Treating FPHL - ✔✔MINOXIDIL
spironolactone
finasteride
, ✔✔What ethnicity has the least likely chance of having bad hot flashes? - ✔✔Japanese
✔✔What ethnicity is the most likely to have bad hot flashes? - ✔✔black
more frequent, longer duration.
✔✔Median length of hot flashes - ✔✔10 years, early menopause transition women have
them the longest.
✔✔Theories about etiology of hot flashes (6) - ✔✔lower ovarian estradiol
thermoregulation zone is narrowed
neurokinins-regulate GnRH secretion. KNDy new meds
serotonin
cortisol and HPI axis dysregulation
endothelial dysfunction.
✔✔VIN
low grade-what to do
high grade-what to do
differentiated VIN-what to do - ✔✔low grade is not precancerous
high grade is precancerous-GYN ONC
differentiated-wide local excision-high risk of invasive carcinoma.
✔✔most common type of vulvar cancer - ✔✔squamous cell carcinoma
✔✔Vulvar disorder commonly misdiagnosed as eczema or dermatitis? - ✔✔paget's
disease
will not improve on steroids
screen for co-existing breast, GI or GU cancer. They are present 20-30% of the time.
✔✔Normal PVR - ✔✔<100mL
✔✔systemic and vaginal estrogen will not help with this type of urinary incontinence? -
✔✔will NOT help with stress incontinence.
✔✔Which topical vaginal estrogen has the highest dose? - ✔✔the vaginal rings
FEMRING IS THE HIGHEST
✔✔Most common cause of vulvovaginitis? - ✔✔BV
✔✔post menopause burning and diffuse yellow/brown discharge and dyspareunia that
does not respond to local ET? - ✔✔desquamative inflammatory vaginitis. treat different
with clindamycin or hydrocortisone+ET
QUESTIONS WITH ANSWERS GRADED A+
✔✔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 and contribute to cycle irregularity.
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.
Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol
concentration.
,✔✔Do cortisol levels associate with VMS severity? - ✔✔No, cortisol levels have NOT
been associated with more severe VMS.
✔✔Local DHEA has been proven to help with what? - ✔✔vaginal pain and dyspareunia
✔✔How to DX POI? - ✔✔(Cannot use standard dx criterion for meno)
1. Presence of menstrual disturbance like oligomenorrhea (infrequent cycles) or
amenorrhea for at least 4 months.
AND
2. elevated FSH level over 25 IU/L on two occasions at least 4 weeks apart.
✔✔Anyone <40years old who misses 3+ consecutive cycles gets these labs -
✔✔prolactin
FSH
estradiol
TSH
pregnancy test
✔✔treatment of POI - ✔✔Hormone Therapy for POI:
100 microgram estradiol patch OR
1.25 mg Conjugated equine estrogens OR
2mg oral estradiol
If intact uterus-progesterone for 12 days of the month.
Physiologic HT is better than continuous hormonal contraception, but if menorrhagia-
IUD plus estrogen patch, or if really not wanting to risk pregnancy, continuous HRT can
be used.
Length: Until the average age of natural menopause
✔✔Hair loss. Difference between FPHL and telogen effluvium? - ✔✔FPHL is gradual,
telogen effluvium is sudden and usually precipitated by a life stressor, chronic illness,
beta blockers or anticoagulants-usually more patchy hair loss.
✔✔FPHL pattern - ✔✔thinning at the crown of the head and widening of the hair part
✔✔Treating FPHL - ✔✔MINOXIDIL
spironolactone
finasteride
, ✔✔What ethnicity has the least likely chance of having bad hot flashes? - ✔✔Japanese
✔✔What ethnicity is the most likely to have bad hot flashes? - ✔✔black
more frequent, longer duration.
✔✔Median length of hot flashes - ✔✔10 years, early menopause transition women have
them the longest.
✔✔Theories about etiology of hot flashes (6) - ✔✔lower ovarian estradiol
thermoregulation zone is narrowed
neurokinins-regulate GnRH secretion. KNDy new meds
serotonin
cortisol and HPI axis dysregulation
endothelial dysfunction.
✔✔VIN
low grade-what to do
high grade-what to do
differentiated VIN-what to do - ✔✔low grade is not precancerous
high grade is precancerous-GYN ONC
differentiated-wide local excision-high risk of invasive carcinoma.
✔✔most common type of vulvar cancer - ✔✔squamous cell carcinoma
✔✔Vulvar disorder commonly misdiagnosed as eczema or dermatitis? - ✔✔paget's
disease
will not improve on steroids
screen for co-existing breast, GI or GU cancer. They are present 20-30% of the time.
✔✔Normal PVR - ✔✔<100mL
✔✔systemic and vaginal estrogen will not help with this type of urinary incontinence? -
✔✔will NOT help with stress incontinence.
✔✔Which topical vaginal estrogen has the highest dose? - ✔✔the vaginal rings
FEMRING IS THE HIGHEST
✔✔Most common cause of vulvovaginitis? - ✔✔BV
✔✔post menopause burning and diffuse yellow/brown discharge and dyspareunia that
does not respond to local ET? - ✔✔desquamative inflammatory vaginitis. treat different
with clindamycin or hydrocortisone+ET
