NAMS MENOPAUSE Certification Latest
Exam 2 Questions and Researched Answers
Phases during menopause transition and PMS symptoms CORRECT ANSWER: Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? CORRECT ANSWER: many pitfalls, variable
depending on the day of the cycle you draw the lab, normal or low FSH is not helpful.
The potentially superior marker of menopause, a lab. CORRECT ANSWER: AMH
DHEA (dehydroepiandrosterone) CORRECT ANSWER: Adrenal androgens: precursor hromones
produced by the adrenal gland that are enzymatically converted to active androgens or estrogens in
peripheral tissues.
Location of estrogen receptors CORRECT ANSWER: Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue CORRECT ANSWER: maintain blood flow, the collagen, and HA within
the epithelial surfaces. Supports microbiome which supports acidity of vagina and protects tissue from
pathogens.
Vaginal changes with menopause CORRECT ANSWER: Thinning, loss of elasticity, loss or absence or
rugae.
Vagina and urethra in menopause CORRECT ANSWER: vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence CORRECT ANSWER: Vaginal estrogen and urinary incontinence: what
type does it help with?
Treatment for FPHL CORRECT ANSWER: Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin?
CORRECT ANSWER: -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? CORRECT
ANSWER: 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? CORRECT ANSWER: 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 CORRECT ANSWER: 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.
Late menopause transition (-1) FSH level on random draw CORRECT ANSWER: 25 or higher
Black women have higher or lower FSH levels? CORRECT ANSWER: Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic
women? CORRECT ANSWER: lower
Menopause transition-changes in SHBG and testosterone? ratio? CORRECT ANSWER: SHBG
decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what? CORRECT ANSWER: The free androgen index
What stage are VMS more likely? CORRECT ANSWER: +1b (generally last 2 years)
What hormone is generally higher in obese women? CORRECT ANSWER: Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones? CORRECT ANSWER:
testosterone and androstenedione
Surgical menopause causes women to have lower levels of what hormone? CORRECT ANSWER:
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?
CORRECT ANSWER: 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? CORRECT ANSWER: Luteal-
more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition CORRECT ANSWER: 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? CORRECT ANSWER:
progesterone
What region of the adrenal gland secretes the androgens? CORRECT ANSWER: zona reticularis
what are considered the 'adrenal androgens'? CORRECT ANSWER: DHEA, DHEAS,
Androstenedione.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors.
CORRECT ANSWER: Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted
by the anterior pituitary.
, What part of the pituitary gland secretes adrenocorticotropic hormone? CORRECT ANSWER:
Anterior pituitary. The posterior only secretes vasopressin and oxytosin.
Cortisol and HRT CORRECT ANSWER: 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? CORRECT ANSWER: No, cortisol levels have NOT
been associated with more severe VMS.
Local DHEA has been proven to help with what? CORRECT ANSWER: vaginal pain and dyspareunia
How to DX POI? CORRECT ANSWER: Menstrual disturbance-oligomenorrhea or amenorrhea for at
least 4 months.
AND
elevated FSH over 25 on two occasions at least 4 weeks apart.
Anyone <40years old who misses 3+ consecutive cycles gets these labs CORRECT ANSWER:
prolactin
FSH
estradiol
TSH
pregnancy test
treatment of POI CORRECT ANSWER: 100 microgram estradiol patch
1.25 mg CEE
2mg oral estradiol
If intact uterus-progesterone for 12 days of the month.
Physiologic is better than continuous hormonal contractption, but if menorrhagia-IUD plus estrogen
patch, or if really not wanting to risk pregnancy, continuous HRT can be used.
Hair loss. Difference between FPHL and telogen effluvium? CORRECT ANSWER: 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 CORRECT ANSWER: thinning at the crown of the head and widening of the hair part
Treating FPHL CORRECT ANSWER: MINOXIDIL
spironolactone
finasteride
Exam 2 Questions and Researched Answers
Phases during menopause transition and PMS symptoms CORRECT ANSWER: Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? CORRECT ANSWER: many pitfalls, variable
depending on the day of the cycle you draw the lab, normal or low FSH is not helpful.
The potentially superior marker of menopause, a lab. CORRECT ANSWER: AMH
DHEA (dehydroepiandrosterone) CORRECT ANSWER: Adrenal androgens: precursor hromones
produced by the adrenal gland that are enzymatically converted to active androgens or estrogens in
peripheral tissues.
Location of estrogen receptors CORRECT ANSWER: Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue CORRECT ANSWER: maintain blood flow, the collagen, and HA within
the epithelial surfaces. Supports microbiome which supports acidity of vagina and protects tissue from
pathogens.
Vaginal changes with menopause CORRECT ANSWER: Thinning, loss of elasticity, loss or absence or
rugae.
Vagina and urethra in menopause CORRECT ANSWER: vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence CORRECT ANSWER: Vaginal estrogen and urinary incontinence: what
type does it help with?
Treatment for FPHL CORRECT ANSWER: Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin?
CORRECT ANSWER: -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? CORRECT
ANSWER: 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? CORRECT ANSWER: 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 CORRECT ANSWER: 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.
Late menopause transition (-1) FSH level on random draw CORRECT ANSWER: 25 or higher
Black women have higher or lower FSH levels? CORRECT ANSWER: Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic
women? CORRECT ANSWER: lower
Menopause transition-changes in SHBG and testosterone? ratio? CORRECT ANSWER: SHBG
decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what? CORRECT ANSWER: The free androgen index
What stage are VMS more likely? CORRECT ANSWER: +1b (generally last 2 years)
What hormone is generally higher in obese women? CORRECT ANSWER: Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones? CORRECT ANSWER:
testosterone and androstenedione
Surgical menopause causes women to have lower levels of what hormone? CORRECT ANSWER:
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?
CORRECT ANSWER: 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? CORRECT ANSWER: Luteal-
more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition CORRECT ANSWER: 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? CORRECT ANSWER:
progesterone
What region of the adrenal gland secretes the androgens? CORRECT ANSWER: zona reticularis
what are considered the 'adrenal androgens'? CORRECT ANSWER: DHEA, DHEAS,
Androstenedione.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors.
CORRECT ANSWER: Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted
by the anterior pituitary.
, What part of the pituitary gland secretes adrenocorticotropic hormone? CORRECT ANSWER:
Anterior pituitary. The posterior only secretes vasopressin and oxytosin.
Cortisol and HRT CORRECT ANSWER: 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? CORRECT ANSWER: No, cortisol levels have NOT
been associated with more severe VMS.
Local DHEA has been proven to help with what? CORRECT ANSWER: vaginal pain and dyspareunia
How to DX POI? CORRECT ANSWER: Menstrual disturbance-oligomenorrhea or amenorrhea for at
least 4 months.
AND
elevated FSH over 25 on two occasions at least 4 weeks apart.
Anyone <40years old who misses 3+ consecutive cycles gets these labs CORRECT ANSWER:
prolactin
FSH
estradiol
TSH
pregnancy test
treatment of POI CORRECT ANSWER: 100 microgram estradiol patch
1.25 mg CEE
2mg oral estradiol
If intact uterus-progesterone for 12 days of the month.
Physiologic is better than continuous hormonal contractption, but if menorrhagia-IUD plus estrogen
patch, or if really not wanting to risk pregnancy, continuous HRT can be used.
Hair loss. Difference between FPHL and telogen effluvium? CORRECT ANSWER: 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 CORRECT ANSWER: thinning at the crown of the head and widening of the hair part
Treating FPHL CORRECT ANSWER: MINOXIDIL
spironolactone
finasteride
