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NAMS Certification Exam 2023 (Graded A+)

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NAMS 1

NAMS Certification Exam 2023 (Graded A+)

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

, NAMS 2

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 +2 - late menopause 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 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.

, NAMS 3

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? - -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? - Cycle day #3. Elevated estradiol can suppress FSH giving a

falsely normal FSH level.

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