NAMS MENOPAUSE CERTIFICATION FINAL
PAPER 2026 QUESTIONS WITH ANSWERS
GRADED A+
◉ Perimenopause Menopause Transition, Early
List the STRAW Stage
What defines the phase? Answer: STRAW Stage: (Stage -2)
Persistent difference of 7 days or more in the length of consecutive
cycles.
◉ Perimenopause Menopause Transition, Late
List the STRAW Stage
What defines the phase? Answer: STRAW Stage: (Stage -1)
60 or more consecutive days of amenorrhea
◉ Luteal out of phase event (LOOP). Answer: Explains why some
perimenopausal women have elevated estrogen level sometimes...In the
early menopause transition, elevated 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 phase of the ongoing
ovulatory cycle.
,◉ Describe the E2 level during the life of a patient with obesity..
Answer: 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 postmenopausal
patients with obesity.
◉ In comparison to other ethnicities, Chinese and Japanese women have
___ E2 levels? Answer: These ethnic groups have lower estradiol levels
than white, black and hispanic women.
◉ STRAW Stage +2, describe the timeline as well as the predominant
symptoms.. Answer: Postmenopause, Late. (Remaining Lifespan) 5-8
years after FMP. Somatic aging predominates. Increased genitourinary
symptoms.
◉ Stages +1a, +1b, +1c, describe the timeline as well as the supportive
criteria and the symptoms.. Answer: 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.
◉ Elevated FSH, LH. Answer: Endocrine labs after menopause
,◉ AMH, Inhibin B. Answer: These hormones work during reproductive
years to not deplete follicle pool too quickly.
◉ Describe the phases during the early menopause transition and what
happens with PMS symptoms. Answer: Menstrual cycle shortens. Due to
unrestrained FSH, follicular phase compresses. More premenstrual
symptoms due to the longer luteal phase. Cycle irregularity and skipped
cycles because of ovulatory failure and increased atresia.
◉ How to respond if a patient requests FSH lab? Answer: many pitfalls,
variable depending on the day of the cycle you draw the lab, normal or
low FSH is not helpful.
◉ What lab is potentially the superior marker of time to menopause?
Answer: AMH
◉ DHEA (dehydroepiandrosterone). Answer: Adrenal androgens:
precursor hromones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in peripheral
tissues.
◉ Location of GU estrogen receptors (4). Answer: Vagina, vulva,
urethra, trigone of the bladder
, ◉ List the effects of estrogen on tissue (4+2). Answer: 1 ) maintains
blood flow to tissue, maintains the collagen within the epithelium, and
maintains the hyaluronic acid and mucopolysaccharides within the
moistened epithelial surface, maintains pH (4.5) 2) supports microbiome
and protects tissue from pathogens
◉ List the vaginal changes with menopause you might note on
clinical/microscopic exam.. Answer: Thinning of the epithelial layer,
loss of elasticity with narrowing of the canal and poor distention, noted
on pelvic exam with loss or absence or rugae. Due to the decrease in
glycogen content, the lactobacilli are decreased resulting in higher pH.
◉ List the vulvar and urethral changes in menopause.. Answer: Thinning
of the epithelial layers and vagina narrowing leads the urethra to move
closer to the introitus.
◉ Stress urinary incontinence. Answer: Vaginal estrogen and urinary
incontinence: what type does it help with?
◉ Treatment for FPHL. Answer: Minoxidil, spironolactone, finasteride,
estrogen therapy
◉ Late reporoductive years -3b and -3a. What happens with menstrual
cycles, FSH, AMH, AFC, inhibin? Answer: -3b: menstrual cycles
normal, FSH normal, AMH low, AFC low, inhibin low.
PAPER 2026 QUESTIONS WITH ANSWERS
GRADED A+
◉ Perimenopause Menopause Transition, Early
List the STRAW Stage
What defines the phase? Answer: STRAW Stage: (Stage -2)
Persistent difference of 7 days or more in the length of consecutive
cycles.
◉ Perimenopause Menopause Transition, Late
List the STRAW Stage
What defines the phase? Answer: STRAW Stage: (Stage -1)
60 or more consecutive days of amenorrhea
◉ Luteal out of phase event (LOOP). Answer: Explains why some
perimenopausal women have elevated estrogen level sometimes...In the
early menopause transition, elevated 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 phase of the ongoing
ovulatory cycle.
,◉ Describe the E2 level during the life of a patient with obesity..
Answer: 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 postmenopausal
patients with obesity.
◉ In comparison to other ethnicities, Chinese and Japanese women have
___ E2 levels? Answer: These ethnic groups have lower estradiol levels
than white, black and hispanic women.
◉ STRAW Stage +2, describe the timeline as well as the predominant
symptoms.. Answer: Postmenopause, Late. (Remaining Lifespan) 5-8
years after FMP. Somatic aging predominates. Increased genitourinary
symptoms.
◉ Stages +1a, +1b, +1c, describe the timeline as well as the supportive
criteria and the symptoms.. Answer: 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.
◉ Elevated FSH, LH. Answer: Endocrine labs after menopause
,◉ AMH, Inhibin B. Answer: These hormones work during reproductive
years to not deplete follicle pool too quickly.
◉ Describe the phases during the early menopause transition and what
happens with PMS symptoms. Answer: Menstrual cycle shortens. Due to
unrestrained FSH, follicular phase compresses. More premenstrual
symptoms due to the longer luteal phase. Cycle irregularity and skipped
cycles because of ovulatory failure and increased atresia.
◉ How to respond if a patient requests FSH lab? Answer: many pitfalls,
variable depending on the day of the cycle you draw the lab, normal or
low FSH is not helpful.
◉ What lab is potentially the superior marker of time to menopause?
Answer: AMH
◉ DHEA (dehydroepiandrosterone). Answer: Adrenal androgens:
precursor hromones produced by the adrenal gland that are
enzymatically converted to active androgens or estrogens in peripheral
tissues.
◉ Location of GU estrogen receptors (4). Answer: Vagina, vulva,
urethra, trigone of the bladder
, ◉ List the effects of estrogen on tissue (4+2). Answer: 1 ) maintains
blood flow to tissue, maintains the collagen within the epithelium, and
maintains the hyaluronic acid and mucopolysaccharides within the
moistened epithelial surface, maintains pH (4.5) 2) supports microbiome
and protects tissue from pathogens
◉ List the vaginal changes with menopause you might note on
clinical/microscopic exam.. Answer: Thinning of the epithelial layer,
loss of elasticity with narrowing of the canal and poor distention, noted
on pelvic exam with loss or absence or rugae. Due to the decrease in
glycogen content, the lactobacilli are decreased resulting in higher pH.
◉ List the vulvar and urethral changes in menopause.. Answer: Thinning
of the epithelial layers and vagina narrowing leads the urethra to move
closer to the introitus.
◉ Stress urinary incontinence. Answer: Vaginal estrogen and urinary
incontinence: what type does it help with?
◉ Treatment for FPHL. Answer: Minoxidil, spironolactone, finasteride,
estrogen therapy
◉ Late reporoductive years -3b and -3a. What happens with menstrual
cycles, FSH, AMH, AFC, inhibin? Answer: -3b: menstrual cycles
normal, FSH normal, AMH low, AFC low, inhibin low.
