NAMS MENOPAUSE EXAM
COMPREHENSIVE STUDY GUIDE WITH
COMPLETE SOLUTIONS AND
EXPLANATIONS 2026
⩥ Early menopause. Answer: LMP before age 45
⩥ Late menopause. Answer: LMP after age 54
⩥ Primary ovarian insufficiency. Answer: Menopause that occurs before
age 40
⩥ Early menopause transition (stage -2). Answer: Persistent difference
of 7 days or more in the length of consecutive cycles.
⩥ Late menopause transition (stage -1). Answer: 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.
,⩥ Obese women and estradiol levels during menopause. Answer: 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. Answer: These ethnic groups have
lower estradiol levels then white, black and hispanic women.
⩥ stage +2. Answer: late menopause stage: 5-8 years after FMP. Somatic
aging predominates. Increased genitourinary symptoms.
⩥ Stages +1a, +1b, +1c. Answer: early post menopause: 2 years after
FMP. FSH rises, estradiol decreases. VMS predominate.
⩥ 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.
⩥ Phases during menopause transition and PMS symptoms. Answer:
Menstrual cycle variable, persistent >7 day difference between
difference in length of consecutive cycles.
,⩥ 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.
⩥ The potentially superior marker of menopause, a lab.. 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 estrogen receptors. Answer: Vagina, vulva, urethra,
trigone of the bladder
⩥ Effects of estrogen on tissue. 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. Answer: Thinning, loss of elasticity,
loss or absence or rugae.
⩥ Vagina and urethra in menopause. Answer: vagina narrows, urethra
moves 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.
-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?. 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?. Answer: produced by granulosa cells
COMPREHENSIVE STUDY GUIDE WITH
COMPLETE SOLUTIONS AND
EXPLANATIONS 2026
⩥ Early menopause. Answer: LMP before age 45
⩥ Late menopause. Answer: LMP after age 54
⩥ Primary ovarian insufficiency. Answer: Menopause that occurs before
age 40
⩥ Early menopause transition (stage -2). Answer: Persistent difference
of 7 days or more in the length of consecutive cycles.
⩥ Late menopause transition (stage -1). Answer: 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.
,⩥ Obese women and estradiol levels during menopause. Answer: 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. Answer: These ethnic groups have
lower estradiol levels then white, black and hispanic women.
⩥ stage +2. Answer: late menopause stage: 5-8 years after FMP. Somatic
aging predominates. Increased genitourinary symptoms.
⩥ Stages +1a, +1b, +1c. Answer: early post menopause: 2 years after
FMP. FSH rises, estradiol decreases. VMS predominate.
⩥ 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.
⩥ Phases during menopause transition and PMS symptoms. Answer:
Menstrual cycle variable, persistent >7 day difference between
difference in length of consecutive cycles.
,⩥ 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.
⩥ The potentially superior marker of menopause, a lab.. 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 estrogen receptors. Answer: Vagina, vulva, urethra,
trigone of the bladder
⩥ Effects of estrogen on tissue. 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. Answer: Thinning, loss of elasticity,
loss or absence or rugae.
⩥ Vagina and urethra in menopause. Answer: vagina narrows, urethra
moves 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.
-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?. 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?. Answer: produced by granulosa cells
