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Comprehensive Study Guide for the
2025 NAMS Menopause Certification
Exam (FREQUENTLTY TESTED
QUESTIONS)
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.
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
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 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 25 or higher Black women have higher or lower FSH levels? Higher Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic women?
lower Menopause transition-changes in SHBG and testosterone? ratio? SHBG decreases 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
What region of the adrenal gland secretes the androgens? zona reticularis what are considered the 'adrenal androgens'? DHEA, DHEAS, Androstenedione. The Climacteric phase 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.
What part of the pituitary gland secretes adrenocorticotropic hormone? Anterior pituitary. The posterior only secretes vasopressin and oxytosin. Cortisol and HRT 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? No, cortisol levels have NOT been associated with more severe VMS. Local DHEA has been proven to help with what? vaginal pain and dyspareunia
How to DX POI? Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months. AND 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.
What ethnicity is the most likely to have bad hot flashes? black more frequent, longer duration. Median length of hot flashes 10 years, early menopause transition women have them the longest. Theories about etiology of hot flashes (6) lower ovarian estradiol thermoregulation zone is narrowed neurokinins-regulate GnRH secretion. KNDy new meds serotonin cortisol and HPI axis dysregulation endothelial dysfunction. VIN low grade-what to do high grade-what to do differentiated VIN-what to do low grade is not precancerous high grade is precancerous-GYN ONC
differentiated-wide local excision-high risk of invasive carcinoma. most common type of vulvar cancer squamous cell carcinoma 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?
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 FOD (orgasmic disorder) treatments directed masturbation is most researched behavioral treatment. Does systemic ET cause fibroids to resume growth? Rarely. They often shrink after menopause. What is true about cognition and menopause? Difficulty concentrating and remembering are common.
What is true about cognition and surgical menopause memory for verbal information can be compromised immediately after surgical menopause, especially if it is before the typical age of mesopause. Meta analysis of RCTs have shown small benefit of what diet/exercise for global cognition and memory? Mediterranean diet with olive oil and tai chi exercise helps with global cognition Mediterranean diet with olive oil and isoflavone supplements helps with memory. effect of HRT on cognition 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
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? it can take several months. what is th emost common form of arthritis? osteoarthritis
what areas of th ebrain have th emost estrogen receptors? hippocampus and prefrontal cortex what is the most common thyroid disorder in women? hashimoto thyroiditis if a patient on levothyroxine is started on estrogen, when do you recheck and what can you anticipate happening? recheck 6-8 weeks later. anticipate that the dose of levothyroxine may need to be increased. oral estrogens increase thyroid binding globulin which in turn reduces the levels of free T4. when is treatment of subclinical hypothyroidism recommended? when the TSH level is higher than 10. are hot or cold thyroid nodules typically most likely to be malignant? cold nodules
