NAMs Menopause Certification Exam With Complete Solutions Latest updates

NAMs Menopause Certification Exam With Complete Solutions Latest updates Climacteric phase - ✔✔The period o f 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 p erimenopausal 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 postme nopause 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 meno pause 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 variable, persistent >7 day difference between difference in length of consecutive cycles. 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 m arker 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 recepto rs - ✔✔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 which supports acidity of vagina 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, A MH 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. AMH produced by... used to test... Is it a screening tool for fertility? When does i t 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. It is influenced by exogenous hormones. Lower in hormonal contraception users, but increases after d/cing.