Download 2024 - NAMS Menopause Certification Exam Study Set 2025-2026 VERIFIED 200 Questions With and more Exams Community Corrections in PDF only on Docsity!
2024 - NAMS Menopause Certification
Exam Study Set 2025-2026 VERIFIED
200 Questions With Correct Answers.
SOLUTION A
Secondary causes of osteoporosis
which 3 common drugs?
Hyperthyroidism, hyperparathyroidism, hypercalciuria, certain drugs (eg: tamoxifen, steroids, PPIs), calcium/vitamin D deficiency, RA, celiac disease, malabsorptive diseases such as Crohn disease, and ulcerative colitis
Median age of menopause in US women
52.54 y
POI
Intermittent ovarian function & insufficient estrogen levels occurring at age <40 y
which STRAW stage?
menarche / early reproductive
which STRAW stage?
peak reproductive
which STRAW stage?
late reproductive
which STRAW stage?
perimenopause
which STRAW stage?
FMP &
12 months after final menstrual period
which STRAW stage?
amenorrhea >60 days
aka late menopause transition
which STRAW stage?
variable cycle lengths of >7 days differences
aka early menopause transition
difference between menopause transition vs perimenopause per STRAW criteria?
menopause transition: - 2 and - 1, prior to FMP
perimenopause: - 2 to +1a, includes 12 mo of amenorrhea following FMP
which STRAW stage?
initial drop in AMH/AFC/inhibin, cycles still regular, FSH normal
aka late reproductive
which STRAW stage?
cycles shorter, first increase in FSH
aka late reproductive
levels spike with ovulation, marker of ovarian reserve
inhibin B
Produced by granulosa cells of activated follicles, most reflective of true ovarian reserve; provides the best single prediction of time to menopause
AMH
what day of cycle to draw FSH to predict ovarian response/reserve?
day 3
—Growing fibroids
—Risk of endometrial hyperplasia
- longer time in luteal phase (worsening PMDD in peri)
premenopausal vs postmenopausal estradiol levels in obesity
pre: lower, more anovulatory cycles
post: higher
consequence of inhibin B and AMH drop in early menopause transition?
FSH spikes --> fast growth of remaining follicles (twins more likely) --> shorter follicular phase --> follicle atresia --> LOOP cycles --> pronounced PMS sx from longer luteal phase --> cycle irregularity by >7 days
dec ovarian reserve causes the drop in what 2 hormones?
inhibin B and AMH
4 adrenal androgens
—Dehydroepiandrosterone (DHEA)
—Dehydroepiandrosterone sulfate (DHEAS)
—Androstenedione
—Testosterone
where are adrenal androgens converted to estrogen?
peripheral tissue
what happens to DHEA levels during menopause transition?
transient increase then return to premenopause baseline
is DHEA supplementation in menopause recommended?
no
(Systematic review and meta-analysis of DHEA use in postmenopausal women with normal adrenal function found no evidence of improvement in sexual symptoms, serum lipids, serum glucose, weight, or bone mineral density)
dx of POI?
amenorrhea >4 mo in age <
FSH >25 on 2 occasions
4 etiologies of POI
most common?
(1) Genetic (turner, fragile X)
estrogen options for POI
100 μg transdermal estradiol patch
1.25 mg conjugated equine estrogens (CEE)
2 mg of estradiol PO
progestin therapy for POI
If uterus is present, cyclical progestins should be added ≥12 d/mo
estrogen maintains what pH in the vagina?
acidic, 3.8 - 4.
high BMI associated with (increase/decrease) in severity of VMS in menopause transition
increase
% skin collagen loss in 1st 5 yrs after menopause
30%
(2% per yr decline over next 20 yrs)
2 most common causes of hair loss in menopause transition
Female pattern hair loss (FPHL; thinning on crown) and telogen effluvium (sudden onset of hair shedding, stress-induced)
tx of FPHL
topical minoxidil (FDA-approved)
spiro/finasteride (off label)
median duration of VMS
7 - 10 yrs
ethnic group with most VMS?
ethnic group with least VMS?
black
japanese
RFs for VMS
•Low socioeconomic status
•Low educational attainment
•Obesity (only in perimenopause)
•Tobacco/Nicotine use
Gabapentin
Clonidine
Oxybutynin
which vaginal lesions should be biopsied?
white, pigmented, or thickened lesions
other populations who get GSM (ie: other prolonged low estrogen states)
prolonged lactation
hypothalamic amenorrhea
POI
Chemo/radiation
GnRH agonists
Aromatase inhibitors
Non-hormonal GSM treatment
when to use?
vaginal lubricants/moisturizers, topical lido
mild/mod GSM, use 1st line (test answer)
hormonal options for GSM
when to use?
vaginal ET
vaginal DHEA
systemic ET (with VMS)
mod to severe GSM, use 2nd line, not studied in breast CA/avoid if able (test answer)
oral option for GSM
ospemifene
antagonist at breast, however, don't use in breast CA (not studied)
ospemifene:
MOA
Risks
Contraindications
Benefits
MOA: SERM --> antagonist on breast, agonist on GU tissue + bone
RF: SMALL inc risk DVT, inc VMS
Contra: Prior DVT/PE
avg serum estradiol level with this?
Estring, 8 pg/mL
others: 3-4 pg/mL (below normal postmeno ranges)
Progesterone needed with local GSM therapies?
Generally no -- estradiol never above 10
consider if pt has other RFs for endometrial CA
which vaginal lesion?
vulva, itchy, white
lichen sclerosis
which vaginal lesion?
vagina, burning, red
lichen planus
tx for both lichen sclerosis & lichen planus
high-potency topical steroids, ointments preferred to creams
(ex: Clobetasol ointment 0.05%, betamethasone ointment 0.05%)
4 Vulvovaginal neoplasias
(1) vulval intraepithelial neoplasia (VIN)
(2) squamous cell carcinoma
(3) basal cell carcinoma
(4) Paget disease
undifferentiated VIN (uVIN)
HPV-related?
lichen sclerosis/planus related?
common/uncommon?
avg age?
yes
no
most common
age <
differentiated VIN (dVIN)
HPV-related?
% of community dwelling women with anal incontinence
9%
age after which natural pregnancy is extremely rare
after age 45
3 disorders now in DSM-5 under the umbrella of female sexual dysfunction (FSD)
(1) Desire: Female Sexual Interest/Arousal Disorder (FSIAD)
(2) Pain: Genito-Pelvic Pain/Penetration Disorder
(3) Orgasm: Female Orgasmic Disorder
new terms for dyspareunia and vaginismus
Genito-Pelvic Pain/Penetration Disorder
new term for HSDD and FAD (female arousal disorder)
Female Sexual Interest/Arousal Disorder (FSIAD)
hormones that increase sexual desire
NE, oxytocin, melanocortins, dopamine
hormones that decrease sexual desire
tryptamine, serotonin, opioids, cannabinoids
2 FDA-approved options for HSDD (now FSIAD)
flibanserin (Addyi)
bremelanotide (Vylessi)
global consensus position on testosterone use for HSDD/FSIAD?
use it!! greatly improves sexual function and QOL
no severe AEs with physiologic use
what to Rx for testosterone for HSDD/FSIAD?
FDA-approved male testosterone formulations, use 1/10th the dose
transverse perineal, bulbospongiosus, ischiocavernosus
superficial pelvic floor muscles
