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NAMS Certification Exam 2023 (Graded A+)
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NAMS 1NAMS Certification Exam 2023 (Graded A+)
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
, NAMS 2
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 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? - 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.
, NAMS 3
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 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.
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