NAMS Menopause Certification Exam V2
1. 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.
2. 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.
3. 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.
4. AFC: Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability pool offollicles.
5. Late menopause transition (-1) FSH level on random draw: 25 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. Menopause transition-changes in SHBG and testosterone? ratio?: SHBGdecreases
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 thisdo 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.
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'?: DHEA, DHEAS, Androstene-dione.
20. Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main
factors.: Angiotensin II, potassium concentration, adrenocor-ticotropic hormone secreted by
the anterior pituitary.
21. Climacteric phase: The period of endrocrinologic, somatic, and transitory psy-chologic
changes that occur around the time of menopause.
22. Early menopause: LMP before age 45
23. Late menopause: LMP after age 54
24. Primary ovarian insufficiency: Menopause that occurs before age 40
25. Early menopause transition (stage -2): Persistent difference of 7 days or morein the
length of consecutive cycles.
26. Late menopause transition (stage -1): 60 or more consecutive days of amen-orrhea
27. 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.
28. Obese women and estradiol levels during menopause: Obese women are more likely to
, have anovulatory cycles with high estradiol levels. They are also more likely to have lower
premenopause yet higher postmenopause estradiol levelscompared with women of normal
weight. (why they are at higher risk of endometrialcancer)
29. Chinese and Japanese women: These ethnic groups have lower estradiol levelsthen white,
black and hispanic women.
30. stage +2: late menopause stage: 5-8 years after FMP. Somatic aging predomi-nates.
Increased genitourinary symptoms.
31. Stages +1a, +1b, +1c: early post menopause: 2 years after FMP. FSH rises,estradiol
decreases. VMS predominate.
32. Elevated FSH, LH: Endocrine labs after menopause
33. AMH, inhibin B: These hormones work during reproductive years to not depletefollicle
pool too quickly.
34. Phases during menopause transition and PMS symptoms: Menstrual cyclevariable,
persistent >7 day difference between difference in length of consecutive cycles.
35. How to respond if a patient requests FSH lab?: many pitfalls, variable de- pending on the
day of the cycle you draw the lab, normal or low FSH is not helpful.
36. The potentially superior marker of menopause, a lab.: AMH
37. DHEA (dehydroepiandrosterone): Adrenal androgens: precursor hromones produced by
the adrenal gland that are enzymatically converted to active androgensor estrogens in peripheral
tissues.
38. Location of estrogen receptors: Vagina, vulva, urethra, trigone of the bladder
39. Effects of estrogen on tissue: maintain blood flow, the collagen, and HA withinthe
epithelial surfaces. Supports microbiome which supports acidity of vagina and protects tissue
from pathogens.
40. Vaginal changes with menopause: Thinning, loss of elasticity, loss or absenceor rugae.
41. Vagina and urethra in menopause: vagina narrows, urethra moves closer tothe introitus.
42. Stress urinary incontinence: Vaginal estrogen and urinary incontinence: whattype does it
help with?
43. Treatment for FPHL: Minoxidil, spironolactone, finasteride, estrogen therapy
44. What part of the pituitary gland secretes adrenocorticotropic hormone?: -
Anterior pituitary. The posterior only secretes vasopressin and oxytosin.
45. Cortisol and HRT: Most serum cortisol circulates bound to cortisol bindingglobulin.
1. 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.
2. 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.
3. 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.
4. AFC: Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability pool offollicles.
5. Late menopause transition (-1) FSH level on random draw: 25 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. Menopause transition-changes in SHBG and testosterone? ratio?: SHBGdecreases
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 thisdo 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.
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'?: DHEA, DHEAS, Androstene-dione.
20. Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main
factors.: Angiotensin II, potassium concentration, adrenocor-ticotropic hormone secreted by
the anterior pituitary.
21. Climacteric phase: The period of endrocrinologic, somatic, and transitory psy-chologic
changes that occur around the time of menopause.
22. Early menopause: LMP before age 45
23. Late menopause: LMP after age 54
24. Primary ovarian insufficiency: Menopause that occurs before age 40
25. Early menopause transition (stage -2): Persistent difference of 7 days or morein the
length of consecutive cycles.
26. Late menopause transition (stage -1): 60 or more consecutive days of amen-orrhea
27. 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.
28. Obese women and estradiol levels during menopause: Obese women are more likely to
, have anovulatory cycles with high estradiol levels. They are also more likely to have lower
premenopause yet higher postmenopause estradiol levelscompared with women of normal
weight. (why they are at higher risk of endometrialcancer)
29. Chinese and Japanese women: These ethnic groups have lower estradiol levelsthen white,
black and hispanic women.
30. stage +2: late menopause stage: 5-8 years after FMP. Somatic aging predomi-nates.
Increased genitourinary symptoms.
31. Stages +1a, +1b, +1c: early post menopause: 2 years after FMP. FSH rises,estradiol
decreases. VMS predominate.
32. Elevated FSH, LH: Endocrine labs after menopause
33. AMH, inhibin B: These hormones work during reproductive years to not depletefollicle
pool too quickly.
34. Phases during menopause transition and PMS symptoms: Menstrual cyclevariable,
persistent >7 day difference between difference in length of consecutive cycles.
35. How to respond if a patient requests FSH lab?: many pitfalls, variable de- pending on the
day of the cycle you draw the lab, normal or low FSH is not helpful.
36. The potentially superior marker of menopause, a lab.: AMH
37. DHEA (dehydroepiandrosterone): Adrenal androgens: precursor hromones produced by
the adrenal gland that are enzymatically converted to active androgensor estrogens in peripheral
tissues.
38. Location of estrogen receptors: Vagina, vulva, urethra, trigone of the bladder
39. Effects of estrogen on tissue: maintain blood flow, the collagen, and HA withinthe
epithelial surfaces. Supports microbiome which supports acidity of vagina and protects tissue
from pathogens.
40. Vaginal changes with menopause: Thinning, loss of elasticity, loss or absenceor rugae.
41. Vagina and urethra in menopause: vagina narrows, urethra moves closer tothe introitus.
42. Stress urinary incontinence: Vaginal estrogen and urinary incontinence: whattype does it
help with?
43. Treatment for FPHL: Minoxidil, spironolactone, finasteride, estrogen therapy
44. What part of the pituitary gland secretes adrenocorticotropic hormone?: -
Anterior pituitary. The posterior only secretes vasopressin and oxytosin.
45. Cortisol and HRT: Most serum cortisol circulates bound to cortisol bindingglobulin.
