NAMS MENOPAUSE
CERTIFICATION EXAM QUESTIONS
AND CORRECT ANSWERS VERIFIED
2025/2026.
Climacteric phase - ANS The period of endrocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
Early menopause - ANS LMP before age 45
Late menopause - ANS LMP after age 54
Primary ovarian insufficiency - ANS Menopause that occurs before age 40
Early menopause transition (stage -2) - ANS Persistent difference of 7 days or more in the
length of consecutive cycles.
Late menopause transition (stage -1) - ANS 60 or more consecutive days of amenorrhea
Luteal out of phase event (LOOP) - ANS 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.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Obese women and estradiol levels during menopause - ANS 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 - ANS These ethnic groups have lower estradiol levels then
white, black and hispanic women.
stage +2 - ANS late menopause stage: 5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.
Stages +1a, +1b, +1c - ANS early post menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
Elevated FSH, LH - ANS Endocrine labs after menopause
AMH, inhibin B - ANS These hormones work during reproductive years to not deplete follicle
pool too quickly.
Phases during menopause transition and PMS symptoms - ANS Menstrual cycle variable,
persistent >7 day difference between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? - ANS 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. - ANS AMH
DHEA (dehydroepiandrosterone) - ANS 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 - ANS Vagina, vulva, urethra, trigone of the bladder
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Effects of estrogen on tissue - ANS 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 - ANS Thinning, loss of elasticity, loss or absence or rugae.
Vagina and urethra in menopause - ANS vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence - ANS Vaginal estrogen and urinary incontinence: what type does
it help with?
Treatment for FPHL - ANS Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC,
inhibin? - ANS -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? - ANS 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? - ANS produced by granulosa cells
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, 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 - ANS 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 - ANS 25 or higher
Black women have higher or lower FSH levels? - ANS Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and hispanic women? - ANS lower
Menopause transition-changes in SHBG and testosterone? ratio? - ANS SHBG decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what? - ANS The free androgen index
What stage are VMS more likely? - ANS +1b (generally last 2 years)
What hormone is generally higher in obese women? - ANS Estrone-via aromatization.
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
CERTIFICATION EXAM QUESTIONS
AND CORRECT ANSWERS VERIFIED
2025/2026.
Climacteric phase - ANS The period of endrocrinologic, somatic, and transitory psychologic
changes that occur around the time of menopause.
Early menopause - ANS LMP before age 45
Late menopause - ANS LMP after age 54
Primary ovarian insufficiency - ANS Menopause that occurs before age 40
Early menopause transition (stage -2) - ANS Persistent difference of 7 days or more in the
length of consecutive cycles.
Late menopause transition (stage -1) - ANS 60 or more consecutive days of amenorrhea
Luteal out of phase event (LOOP) - ANS 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.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Obese women and estradiol levels during menopause - ANS 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 - ANS These ethnic groups have lower estradiol levels then
white, black and hispanic women.
stage +2 - ANS late menopause stage: 5-8 years after FMP. Somatic aging predominates.
Increased genitourinary symptoms.
Stages +1a, +1b, +1c - ANS early post menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate.
Elevated FSH, LH - ANS Endocrine labs after menopause
AMH, inhibin B - ANS These hormones work during reproductive years to not deplete follicle
pool too quickly.
Phases during menopause transition and PMS symptoms - ANS Menstrual cycle variable,
persistent >7 day difference between difference in length of consecutive cycles.
How to respond if a patient requests FSH lab? - ANS 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. - ANS AMH
DHEA (dehydroepiandrosterone) - ANS 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 - ANS Vagina, vulva, urethra, trigone of the bladder
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Effects of estrogen on tissue - ANS 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 - ANS Thinning, loss of elasticity, loss or absence or rugae.
Vagina and urethra in menopause - ANS vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence - ANS Vaginal estrogen and urinary incontinence: what type does
it help with?
Treatment for FPHL - ANS Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC,
inhibin? - ANS -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? - ANS 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? - ANS produced by granulosa cells
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, 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 - ANS 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 - ANS 25 or higher
Black women have higher or lower FSH levels? - ANS Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white, black
and hispanic women? - ANS lower
Menopause transition-changes in SHBG and testosterone? ratio? - ANS SHBG decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what? - ANS The free androgen index
What stage are VMS more likely? - ANS +1b (generally last 2 years)
What hormone is generally higher in obese women? - ANS Estrone-via aromatization.
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
