NAMs MENOPAUSE CERTIFICATION EXAM 2023-2024 ACTUAL EXAM 250 QUESTIONS AND CORRECT ANSWERS WITH RATIONALES VERIFIED ANSWERS GRADED A+

NAMs MENOPAUSE CERTIFICATION EXAM
2023-2024 ACTUAL EXAM 250 QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES VERIFIED ANSWERS GRADED A+



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 +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.

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?

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.


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.

AMH
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.

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 tr