N A M s
M e n o p a u s e
C e r t i f i c a t i o n
E x a m
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.
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
shortenes,
follicular
phase
compresses,
women
spend
more
time
in
luteal
phase..
meaning
more
premenstrual
symptoms
and
more
frequent
menstrual
periods.
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
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