NAMS MENOPAUSE CERTIFICATION EXAM
Latest Question and Answer (2026/2027) |
Detailed Rationales | A+ Verified
• Climacteric phase -✓✓ The period of endrocrinologic, 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 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.
• 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
levels compared with women of normal weight. (why they are at higher risk of
endometrial cancer)
• Chinese and Japanese women -✓✓ These ethnic groups have lower estradiol
levels then white, black and hispanic women.
• stage +2 -✓✓ late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
• Stages +1a, +1b, +1c -✓✓ early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
• 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, normal or low FSH is not
helpful.
• The potentially superior marker of menopause, a lab. -✓✓ AMH
,• DHEA (dehydroepiandrosterone) -✓✓ 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 -✓✓ Vagina, vulva, urethra, trigone of the
bladder
• Effects of estrogen on tissue -✓✓ 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 -✓✓ Thinning, loss of elasticity, loss or
absence or 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 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.
• When it is appropriate to check an FSH during the cycle if you check it? and
why? -✓✓ 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? -✓✓ 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 -✓✓ Antral follicle count
Number of follicles that are detectable with ultrasound.
Latest Question and Answer (2026/2027) |
Detailed Rationales | A+ Verified
• Climacteric phase -✓✓ The period of endrocrinologic, 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 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.
• 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
levels compared with women of normal weight. (why they are at higher risk of
endometrial cancer)
• Chinese and Japanese women -✓✓ These ethnic groups have lower estradiol
levels then white, black and hispanic women.
• stage +2 -✓✓ late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
• Stages +1a, +1b, +1c -✓✓ early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
• 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, normal or low FSH is not
helpful.
• The potentially superior marker of menopause, a lab. -✓✓ AMH
,• DHEA (dehydroepiandrosterone) -✓✓ 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 -✓✓ Vagina, vulva, urethra, trigone of the
bladder
• Effects of estrogen on tissue -✓✓ 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 -✓✓ Thinning, loss of elasticity, loss or
absence or 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 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.
• When it is appropriate to check an FSH during the cycle if you check it? and
why? -✓✓ 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? -✓✓ 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 -✓✓ Antral follicle count
Number of follicles that are detectable with ultrasound.
