NAMS Menopause Certification Exam V1
1. When it is appropriate to check an FSH during the cycle if you check it? andwhy?: Cycle day
#3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
2. 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 lowovarian
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, butincreases
after d/cing.
3. What does AFC stand for? What is considered a normal value?: AntralFollicle Count
> 12 follicles detectable with ultrasound is considered normal
4. What is the significance of antral follicle count?: The ability of the ovaries to respond. It
can represent the number of follicles detectable with ultrasound. It issensitive to FSH, and
represents the available pool of follicles.
5. What is the FSH level on a random draw in Late menopause transition(STRAW Stage: -
1)?: 25 IU/L or higher
6. Black women have higher or lower FSH levels?: Higher
7. Chinese and Japanese women have higher or lower estradiol levels com-pared to white,
black and hispanic women?: Lower
8. What happens to SHBG during menopause? How does that effect the freeandrogen
index?: SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
9. Testosterone:SHGB ratio is called what?: The free androgen index
10. What stage are VMS more likely?: +1b (generally last 2 years)
11. What hormone is generally higher in obese women?: Estrone-via aromati-zation.
12. The postmenopausal ovary continues to produce what two hormones?: -
,testosterone and androstenedione
13. Surgical menopause causes women to have lower levels of what hor-mone?: Testosterone.
40-50% lower than in women w/ intact ovaries.
14. Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin
B and AMH? What does that do to FSH?: Inhibin B and AMHdecrease.
Decreased InhB leads to unrestrained FSH. This allows for the growth of the remaining,
diminished follicle pool (shortened follicular phase). Increased atresia.Occasional LOOP
cycles.
15. In the menopause transition, women spend more time in what phase?: -
Luteal-more PMS symptoms, more frequent menstrual periods.
16. HPO axis theory and the menopause transition: It is felt that the HPO axismay 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.
17. In the first year after the FMP, there is no production of what hormone?: -
progesterone
18. What region of the adrenal gland secretes the androgens?: zona reticularis
19. What are considered the 'adrenal androgens'?: Precursor hormones pro- duced by the
adrenal gland, which are enzymatically converted to active andro- gens/estrogens in peripheral
tissue.
Dehydroepiandrosterone DHEA Dehydroepiandrosterone-sulfate DHEASAndrostenedione
Testosterone
20. Aldosterone secretion from the zona glomerulosa in the adrenal gland isregulated by 3
main factors:: Angiotensin II (RAAS), Potassium Concentration, ACTH secreted by the
anterior pituitary.
21. What part of the pituitary gland secretes adrenocorticotropic hormone?: -
Anterior pituitary. The posterior only secretes vasopressin and oxytosin.
22. Cortisol and HRT: Most serum cortisol circulates bound to cortisol bindingglobulin.
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 cortisolconcentration.
23. Do cortisol levels associate with VMS severity?: No, cortisol levels have NOT been
associated with more severe VMS.
24. Local DHEA has been proven to help with what? Is routine use recommend- ed?: Vaginal
pain and dyspareunia. Although, routine DHEA use in postmenopausal women is not
recommended.
25. Climacteric phase: The period of endrocrinologic, somatic, and transitory psy-chologic
changes that occur around the time of menopause.
26. Perimenopause Menopause Transition, EarlyList the STRAW Stage
What defines the phase?: STRAW Stage: (Stage -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
27. Perimenopause Menopause Transition, LateList the STRAW Stage
What defines the phase?: STRAW Stage: (Stage -1)60 or more consecutive days of
amenorrhea
28. Luteal out of phase event (LOOP): Explains why some perimenopausal womenhave
elevated estrogen level sometimes...In the early menopause transition, elevat-ed 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 phaseof the ongoing ovulatory cycle.
29. 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 postmenopausalpatients with obesity.
30.
n comparison to other ethnicities, Chinese and Japanese women have E2 levels?: These
ethnic groups have lower estradiol levels than white, black and hispanic women.
31. STRAW Stage +2, describe the timeline as well as the predominant symp- toms.:
Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.
32. 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.
33. Elevated FSH, LH: Endocrine labs after menopause
34. AMH, Inhibin B: These hormones work during reproductive years to not depletefollicle
1. When it is appropriate to check an FSH during the cycle if you check it? andwhy?: Cycle day
#3. Elevated estradiol can suppress FSH giving a falsely normal FSH level.
2. 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 lowovarian
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, butincreases
after d/cing.
3. What does AFC stand for? What is considered a normal value?: AntralFollicle Count
> 12 follicles detectable with ultrasound is considered normal
4. What is the significance of antral follicle count?: The ability of the ovaries to respond. It
can represent the number of follicles detectable with ultrasound. It issensitive to FSH, and
represents the available pool of follicles.
5. What is the FSH level on a random draw in Late menopause transition(STRAW Stage: -
1)?: 25 IU/L or higher
6. Black women have higher or lower FSH levels?: Higher
7. Chinese and Japanese women have higher or lower estradiol levels com-pared to white,
black and hispanic women?: Lower
8. What happens to SHBG during menopause? How does that effect the freeandrogen
index?: SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
9. Testosterone:SHGB ratio is called what?: The free androgen index
10. What stage are VMS more likely?: +1b (generally last 2 years)
11. What hormone is generally higher in obese women?: Estrone-via aromati-zation.
12. The postmenopausal ovary continues to produce what two hormones?: -
,testosterone and androstenedione
13. Surgical menopause causes women to have lower levels of what hor-mone?: Testosterone.
40-50% lower than in women w/ intact ovaries.
14. Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin
B and AMH? What does that do to FSH?: Inhibin B and AMHdecrease.
Decreased InhB leads to unrestrained FSH. This allows for the growth of the remaining,
diminished follicle pool (shortened follicular phase). Increased atresia.Occasional LOOP
cycles.
15. In the menopause transition, women spend more time in what phase?: -
Luteal-more PMS symptoms, more frequent menstrual periods.
16. HPO axis theory and the menopause transition: It is felt that the HPO axismay 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.
17. In the first year after the FMP, there is no production of what hormone?: -
progesterone
18. What region of the adrenal gland secretes the androgens?: zona reticularis
19. What are considered the 'adrenal androgens'?: Precursor hormones pro- duced by the
adrenal gland, which are enzymatically converted to active andro- gens/estrogens in peripheral
tissue.
Dehydroepiandrosterone DHEA Dehydroepiandrosterone-sulfate DHEASAndrostenedione
Testosterone
20. Aldosterone secretion from the zona glomerulosa in the adrenal gland isregulated by 3
main factors:: Angiotensin II (RAAS), Potassium Concentration, ACTH secreted by the
anterior pituitary.
21. What part of the pituitary gland secretes adrenocorticotropic hormone?: -
Anterior pituitary. The posterior only secretes vasopressin and oxytosin.
22. Cortisol and HRT: Most serum cortisol circulates bound to cortisol bindingglobulin.
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 cortisolconcentration.
23. Do cortisol levels associate with VMS severity?: No, cortisol levels have NOT been
associated with more severe VMS.
24. Local DHEA has been proven to help with what? Is routine use recommend- ed?: Vaginal
pain and dyspareunia. Although, routine DHEA use in postmenopausal women is not
recommended.
25. Climacteric phase: The period of endrocrinologic, somatic, and transitory psy-chologic
changes that occur around the time of menopause.
26. Perimenopause Menopause Transition, EarlyList the STRAW Stage
What defines the phase?: STRAW Stage: (Stage -2)
Persistent difference of 7 days or more in the length of consecutive cycles.
27. Perimenopause Menopause Transition, LateList the STRAW Stage
What defines the phase?: STRAW Stage: (Stage -1)60 or more consecutive days of
amenorrhea
28. Luteal out of phase event (LOOP): Explains why some perimenopausal womenhave
elevated estrogen level sometimes...In the early menopause transition, elevat-ed 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 phaseof the ongoing ovulatory cycle.
29. 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 postmenopausalpatients with obesity.
30.
n comparison to other ethnicities, Chinese and Japanese women have E2 levels?: These
ethnic groups have lower estradiol levels than white, black and hispanic women.
31. STRAW Stage +2, describe the timeline as well as the predominant symp- toms.:
Postmenopause, Late. (Remaining Lifespan) 5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.
32. 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.
33. Elevated FSH, LH: Endocrine labs after menopause
34. AMH, Inhibin B: These hormones work during reproductive years to not depletefollicle
