2023 NAMS MENOPAUSE CERTIFICATION ACTUAL EXAM
WITH REAL QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) LATEST 2023-2024
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NAMS MENOPAUSE CERTIFICATION EXAM
How to respond if a patient requests FSH lab? – ANSWER many pitfalls, variable
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 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
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.
Climacteric phase – ANSWER The period of endrocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
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
shortenes, follicular phase compresses, women spend more time in luteal phase..
meaning more premenstrual symptoms and more frequent menstrual periods.
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 – ANSWER Antral follicle count
Number of follicles that are detectable with ultrasound.
They are sensitive to FSH and considered to represent the availability poo of follicles.
Late menopause transition (-1) FSH level on random draw – ANSWER 25 or higher
Black women have higher or lower FSH levels? – ANSWER Higher
Chinese and Japanese women have higher or lower estradiol levels compared to white,
black and hispanic women? – ANSWER lower
Menopause transition-changes in SHBG and testosterone? ratio? – ANSWER SHBG
decreases
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what? – ANSWER The free androgen index
What stage are VMS more likely? – ANSWER +1b (generally last 2 years)
What hormone is generally higher in obese women? – ANSWER Estrone-via
aromatization.
The postmenopausal ovary continues to produce what two hormones? – ANSWER
testosterone and androstenedione
, Surgical menopause causes women to have lower levels of what hormone? – ANSWER
testosterone. 40-50% lower than in women w/ intact ovaries.
Driving piece of menopause is ovarian follicles depleting. What does this do to the
inhibin B and AMH? – ANSWER inhibin and AMH decrease
therefore, follicle growth is not restrained, this allows for the growth of the remaining,
diminished follicle pool.
In the menopause transition, women spend more time in what phase? – ANSWER
Luteal-more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition – ANSWER It is felt that the HPO axis
may become less sensitive to estrogen, so even with good follicle growth and estradiol
secretion, LH surges can fail which can lead to more cycle irregularity.
In the first year after the FMP, there is no production of what hormone? – ANSWER
progesterone
What region of the adrenal gland secretes the androgens? – ANSWER zona reticularis
what are considered the 'adrenal androgens'? – ANSWER DHEA, DHEAS,
Androstenedione.
Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3
main factors. – ANSWER Angiotensin II, potassium concentration, adrenocorticotropic
hormone secreted by the anterior pituitary.
What part of the pituitary gland secretes adrenocorticotropic hormone? – ANSWER
Anterior pituitary. The posterior only secretes vasopressin and oxytosin.
Cortisol and HRT – ANSWER Most serum cortisol circulates bound to cortisol binding
globulin.
Oral estrogen increases the cortisol binding globulin, which increases total cortisol
concentration.
Oral tamoxifen acts similarly.
Transdermal does not increase it, so it has a minimal effect on serum cortisol
concentration.
Do cortisol levels associate with VMS severity? – ANSWER No, cortisol levels have
NOT been associated with more severe VMS.
