NAMS Menopause Certification | Questions and
Answers | 2026 Update | Exam Review Pack
• Climacteric phase -✓✓The period of endocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
• Early menopause -✓✓LMP before age 45.
• Late menopause -✓✓LMP after age 54.
• Primary ovarian insufficiency -✓✓Menopause that occurs before age 40.
• Early menopause transition (stage -2) -✓✓Persistent difference of 7 days or more
in the length of consecutive cycles.
• Late menopause transition (stage -1) -✓✓60 or more consecutive days of
amenorrhea.
• Luteal out of phase event (LOOP) -✓✓Explains why some perimenopausal
women have elevated estrogen levels sometimes.
• Obese women and estradiol levels during menopause -✓✓Obese women are more
likely to have anovulatory cycles with high estradiol levels.
• Chinese and Japanese women -✓✓These ethnic groups have lower estradiol
levels than white, black, and Hispanic women.
• Stage +2 -✓✓Late menopause stage: 5-8 years after FMP. Somatic aging
predominates.
• Stages +1a, +1b, +1c -✓✓Early post menopause: 2 years after FMP. FSH rises,
estradiol decreases.
• Elevated FSH, LH -✓✓Endocrine labs after menopause.
,• AMH, inhibin B -✓✓These hormones work during reproductive years to not
deplete follicle pool too quickly.
• Phases during menopause transition and PMS symptoms -✓✓Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive
cycles.
• How to respond if a patient requests FSH lab? -✓✓Many pitfalls, variable
depending on the day of the cycle you draw the lab.
• The potentially superior marker of menopause, a lab. -✓✓AMH.
• DHEA (dehydroepiandrosterone) -✓✓Adrenal androgens: precursor hormones
produced by the adrenal gland that are enzymatically converted to active androgens
or estrogens in peripheral tissues.
• Location of estrogen receptors -✓✓Vagina, vulva, urethra, trigone of the bladder.
• Effects of estrogen on tissue -✓✓Maintain blood flow, the collagen, and HA
within the epithelial surfaces.
• Vaginal changes with menopause -✓✓Thinning, loss of elasticity, loss or absence
of rugae.
• Vagina and urethra in menopause -✓✓Vagina narrows, urethra moves closer to
the introitus.
• Stress urinary incontinence -✓✓Vaginal estrogen and urinary incontinence: what
type does it help with?
• Treatment for FPHL -✓✓Minoxidil, spironolactone, finasteride, estrogen therapy.
• Late reproductive years -3b and -3a -✓✓-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? -
✓✓Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal
FSH level.
• AFC -✓✓Antral follicle count. Number of follicles that are detectable with
ultrasound.
• Late menopause transition (-1) FSH level on random draw -✓✓25 or higher.
• Black women have higher or lower FSH levels? -✓✓Higher.
• Chinese and Japanese women have higher or lower estradiol levels compared to
white, black and Hispanic women? -✓✓Lower.
• Menopause transition-changes in SHBG and testosterone? -✓✓SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
• Testosterone/SHBG ratio is called what? -✓✓The free androgen index.
• What stage are VMS more likely? -✓✓+1b (generally last 2 years).
• What hormone is generally higher in obese women? -✓✓Estrone-via
aromatization.
• The postmenopausal ovary continues to produce what two hormones? -
✓✓Testosterone and androstenedione.
• 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.
• 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.
Answers | 2026 Update | Exam Review Pack
• Climacteric phase -✓✓The period of endocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
• Early menopause -✓✓LMP before age 45.
• Late menopause -✓✓LMP after age 54.
• Primary ovarian insufficiency -✓✓Menopause that occurs before age 40.
• Early menopause transition (stage -2) -✓✓Persistent difference of 7 days or more
in the length of consecutive cycles.
• Late menopause transition (stage -1) -✓✓60 or more consecutive days of
amenorrhea.
• Luteal out of phase event (LOOP) -✓✓Explains why some perimenopausal
women have elevated estrogen levels sometimes.
• Obese women and estradiol levels during menopause -✓✓Obese women are more
likely to have anovulatory cycles with high estradiol levels.
• Chinese and Japanese women -✓✓These ethnic groups have lower estradiol
levels than white, black, and Hispanic women.
• Stage +2 -✓✓Late menopause stage: 5-8 years after FMP. Somatic aging
predominates.
• Stages +1a, +1b, +1c -✓✓Early post menopause: 2 years after FMP. FSH rises,
estradiol decreases.
• Elevated FSH, LH -✓✓Endocrine labs after menopause.
,• AMH, inhibin B -✓✓These hormones work during reproductive years to not
deplete follicle pool too quickly.
• Phases during menopause transition and PMS symptoms -✓✓Menstrual cycle
variable, persistent >7 day difference between difference in length of consecutive
cycles.
• How to respond if a patient requests FSH lab? -✓✓Many pitfalls, variable
depending on the day of the cycle you draw the lab.
• The potentially superior marker of menopause, a lab. -✓✓AMH.
• DHEA (dehydroepiandrosterone) -✓✓Adrenal androgens: precursor hormones
produced by the adrenal gland that are enzymatically converted to active androgens
or estrogens in peripheral tissues.
• Location of estrogen receptors -✓✓Vagina, vulva, urethra, trigone of the bladder.
• Effects of estrogen on tissue -✓✓Maintain blood flow, the collagen, and HA
within the epithelial surfaces.
• Vaginal changes with menopause -✓✓Thinning, loss of elasticity, loss or absence
of rugae.
• Vagina and urethra in menopause -✓✓Vagina narrows, urethra moves closer to
the introitus.
• Stress urinary incontinence -✓✓Vaginal estrogen and urinary incontinence: what
type does it help with?
• Treatment for FPHL -✓✓Minoxidil, spironolactone, finasteride, estrogen therapy.
• Late reproductive years -3b and -3a -✓✓-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? -
✓✓Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal
FSH level.
• AFC -✓✓Antral follicle count. Number of follicles that are detectable with
ultrasound.
• Late menopause transition (-1) FSH level on random draw -✓✓25 or higher.
• Black women have higher or lower FSH levels? -✓✓Higher.
• Chinese and Japanese women have higher or lower estradiol levels compared to
white, black and Hispanic women? -✓✓Lower.
• Menopause transition-changes in SHBG and testosterone? -✓✓SHBG decreases.
Testosterone/SHBG ratio increases by 80%.
• Testosterone/SHBG ratio is called what? -✓✓The free androgen index.
• What stage are VMS more likely? -✓✓+1b (generally last 2 years).
• What hormone is generally higher in obese women? -✓✓Estrone-via
aromatization.
• The postmenopausal ovary continues to produce what two hormones? -
✓✓Testosterone and androstenedione.
• 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.
• 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.
