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Nams Menopause Certification Exam 2025 Questions With Elaborated Answers.
Typology: Exams
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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 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 +
late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c
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
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?
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.
produced by...
used to test...
Is it a screening tool for fertility?
When does it peak?
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.
Testosterone/SHBG ratio increases by 80%.
Testosterone/SHGB ratio is called what?
The free androgen index
What stage are VMS more likely?
+1b (generally last 2 years)
What hormone is generally higher in obese women?
Estrone-via aromatization.
The postmenopausal ovary continues to produce what two hormones?
testosterone and androstenedione
Surgical menopause causes women to have lower levels of what hormone?
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?
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?
Luteal-more PMS symptoms, more frequent menstrual periods.
HPO axis theory and the menopause transition
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?
progesterone
What region of the adrenal gland secretes the androgens?
zona reticularis
what are considered the 'adrenal androgens'?
DHEA, DHEAS, Androstenedione.
How to DX POI?
Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months.
elevated FSH over 25 on two occasions at least 4 weeks apart.
Anyone <40years old who misses 3+ consecutive cycles gets these labs
prolactin
FSH
estradiol
TSH
pregnancy test
treatment of POI
100 microgram estradiol patch
1.25 mg CEE
2mg oral estradiol
If intact uterus-progesterone for 12 days of the month.
Physiologic is better than continuous hormonal contractption, but if menorrhagia-IUD plus estrogen patch, or if really not wanting to risk pregnancy, continuous HRT can be used.
Hair loss. Difference between FPHL and telogen effluvium?
FPHL is gradual, telogen effluvium is sudden and usually precipitated by a life stressor, chronic illness, beta blockers or anticoagulants-usually more patchy hair loss.
FPHL pattern
thinning at the crown of the head and widening of the hair part
Treating FPHL
MINOXIDIL
spironolactone
finasteride
What ethnicity has the least likely chance of having bad hot flashes?
Japanese
What ethnicity is the most likely to have bad hot flashes?
black
more frequent, longer duration.
Vulvar disorder commonly misdiagnosed as eczema or dermatitis?
paget's disease
will not improve on steroids
screen for co-existing breast, GI or GU cancer. They are present 20-30% of the time.
Normal PVR
<100mL
systemic and vaginal estrogen will not help with this type of urinary incontinence?
will NOT help with stress incontinence.
Which topical vaginal estrogen has the highest dose?
the vaginal rings
FEMRING IS THE HIGHEST
Most common cause of vulvovaginitis?
BV
post menopause burning and diffuse yellow/brown discharge and dyspareunia that does not respond to local ET?
desquamative inflammatory vaginitis. treat different with clindamycin or hydrocortisone+ET
What hormones are associated with sexual desire in women?
circulating androgens
Women who have had a BSO experience an abrupt and persistent decline in what hormone?
circulating androgen levels
HSDD and FSAD were combined into a single dysrunction called
female sexual interest/arousal disorder
HSDD treatments
flibanserin and bremelanotide
FGAD treatments (genital arousal disorder)
L-arginine, topical alprostadil, wellbutrin, oxytosin.
phosphodiesterase inhibitors-lacking in efficacy
Eros therapy device $300- vaccum-like the penis pump
small or no overall effect on cognition
What HRT can increase your risk for dementia based on the WHIMS study in 65+ year old healthy women?
EPT replacement was shown to double the risk of developing dementia.
There was no significant increased risk in ET alone.
this is why HRT is not recommended after 65 for primary prevention of dementia
3 reasons supporting the idea that HRT in early menopause may decrease a woman's chance of developing alzheimer's disease?
Migraine headache and pregnancy
typically migraines improve-estrogen levels stabilize
Migraine without aura after menopause
usually decrease with natural menopause
menstrual migraine after menopause
should resolve completely
When to consider preventative medication for migraines
2 times per week or severe and effecting QOL
Triptans are contraindicated in what?
patients with cardiovascular disease, as are NSAIDs
Menstrual migraine treatment
NSAID or triptan 2 days before expected to get your period, and take for 5-7 days.
cdc and who guidelines for migraine treatment
migraine with aura-advise to not use combined hormone contraception
caution in women with migraine without aura
How long can it take for arthralgia from vitamin d deficiency or hypothyroidism to fully resolve?
are hot or cold thyroid nodules typically most likely to be malignant?
cold nodules
how does HRT impact gallbladder disease?
increases risk of gallstones with oral HRT, lower risk with transdermal.
when did they start screening blood for hep c?
1992, so women who have received blood products or organ transplants prior to 1992 may have acquired heptatitis c
why do we screen for hep C?
most infections become chronic and most are asymptomatic until liver damage is detected years later. Our treatments are improving so if we catch this earlier in people, outcomes will be better
all adults born from what year to what year should recieve one time hep c testing?
1945 to 1965
routine screening of all adults for hepatitis c. is it reocmmended?
routine screening for all adults is not recommended, however baby boomers are at the highest risk. infection rates are 5x other birth cohorts.
what hpv is high risk?
16 and 18
by age 50 what percentage of US women will have acquired a genital HPV infection?
80%-HPV is very common, but it is the high risk ones to worry about
what is the most commonly sexually transmitted infection in the US?
HPV
What percentage of bone loss do women have from the menopause transition?
10 - 12% on average, about 1 t score
What t score defines osteopenia
what t score defines osteoporosis
less than - 2.
