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NAMs Menopause Certification Exam – Q’s & A’s
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NAMs Menopause Certification Exam – Q’s & A’sClimacteric phase Correct Ans - The period of endrocrinologic,
somatic, and transitory psychologic changes that occur around the time of
menopause.
Early menopause Correct Ans - LMP before age 45
Late menopause Correct Ans - LMP after age 54
Primary ovarian insufficiency Correct Ans - Menopause that occurs
before age 40
Early menopause transition (stage -2) Correct Ans - Persistent
difference of 7 days or more in the length of consecutive cycles.
Late menopause transition (stage -1) Correct Ans - 60 or more
consecutive days of amenorrhea
Luteal out of phase event (LOOP) Correct 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 Correct 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 Correct Ans - These ethnic groups
have lower estradiol levels then white, black and hispanic women.
stage +2 Correct Ans - late menopause stage: 5-8 years after FMP.
Somatic aging predominates. Increased genitourinary symptoms.
,Stages +1a, +1b, +1c Correct Ans - early post menopause: 2 years
after FMP. FSH rises, estradiol decreases. VMS predominate.
Elevated FSH, LH Correct Ans - Endocrine labs after menopause
AMH, inhibin B Correct Ans - These hormones work during
reproductive years to not deplete follicle pool too quickly.
Phases during menopause transition and PMS symptoms Correct Ans -
Menstrual cycle variable, persistent >7 day difference between difference
in length of consecutive cycles.
How to respond if a patient requests FSH lab? Correct 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. Correct Ans -
AMH
DHEA (dehydroepiandrosterone) Correct 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 Correct Ans - Vagina, vulva, urethra,
trigone of the bladder
Effects of estrogen on tissue Correct 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 Correct Ans - Thinning, loss of
elasticity, loss or absence or rugae.
Vagina and urethra in menopause Correct Ans - vagina narrows,
urethra moves closer to the introitus.
Stress urinary incontinence Correct Ans - Vaginal estrogen and
urinary incontinence: what type does it help with?
, Treatment for FPHL Correct Ans - Minoxidil, spironolactone,
finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles,
FSH, AMH, AFC, inhibin? Correct 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? Correct 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? Correct Ans - 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 Correct 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 Correct Ans
- 25 or higher
Black women have higher or lower FSH levels? Correct Ans - Higher
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