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NAMS MENOPAUSE CERTIFICATION
EXAM 2025 ACTUAL EXAM 270
QUESTIONS WITH DETAILED VERIFIED
ANSWERS ALREADY GRADED A+
LATEST VERSION
"List the vaginal changes with menopause you might note on clinical/microscopic exam. - CORRECT ANSWER=> Thinning of the epithelial layer, loss of elasticity with narrowing of the canal and poor distention, noted on pelvic exam with loss or absence of rugae. Due to the decrease in glycogen content, the lactobacilli are decreased resulting in higher pH." "List the vulvar and urethral changes in menopause. - CORRECT ANSWER=> Thinning of the epithelial layers and vagina narrowing leads the urethra moves closer to the introitus." "Stress urinary incontinence - CORRECT ANSWER=> Vaginal estrogen and urinary incontinence: what type does it help with?" "Treatment for FPHL - CORRECT ANSWER=> Minoxidil, spironolactone, finasteride, estrogen therapy" "Late reproductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? - CORRECT ANSWER=> -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? why? - CORRECT ANSWER=> 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? - CORRECT ANSWER=> 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." "What does AFC stand for? What is considered a normal value? - CORRECT ANSWER=> Antral Follicle Count
12 follicles detectable with ultrasound is considered normal" "What is the significance of antral follicle count? - CORRECT ANSWER=> The ability of the ovaries to respond. It can represent the number of follicles detectable with ultrasound. It is sensitive to FSH, and represents the available pool of follicles." "What is the FSH level on a random draw in Late menopause transition (STRAW Stage: -1)? - CORRECT ANSWER=> >/= 25 IU/L" "Black women have higher or lower FSH levels? - CORRECT ANSWER=> Higher" "Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic women? - CORRECT ANSWER=> Lower" "What happens to SHBG during menopause? How does that effect the free androgen index? - CORRECT ANSWER=> SHBG decreases. Testosterone/SHBG ratio increases by 80%."
Androstenedione Testosterone" "Aldosterone secretion from the zona glomerulosa in the adrenal gland is regulated by 3 main factors: - CORRECT ANSWER=> Angiotensin II (RAAS), Potassium Concentration, ACTH secreted by the anterior pituitary." "What part of the pituitary gland secretes adrenocorticotropic hormone? - CORRECT ANSWER=> Anterior pituitary. The posterior only secretes vasopressin and oxytosin." "Cortisol and HRT - CORRECT ANSWER=> 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? - CORRECT ANSWER=> No, cortisol levels have NOT been associated with more severe VMS." "Local DHEA has been proven to help with what? Is routine use recommended? - CORRECT ANSWER=> Vaginal pain and dyspareunia. Although, routine DHEA use in postmenopausal women is not recommended." "Diagnostic criteria, POI includes: - CORRECT ANSWER=> Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months. AND Elevated FSH over 25 on two occasions at least 4 weeks apart., with low estradiol." "Anyone <40years old who misses 3+ consecutive cycles gets these labs: - CORRECT ANSWER=> prolactin FSH estradiol
TSH
pregnancy test *also consider karyotype, FMR1 gene mutation, adrenal Ab (ACTH), glucose, calcium, phosphorus, pelvic US, and BMD" "What are the medications and doses used in the treatment of POI? What is the duration of therapy? - CORRECT ANSWER=> 100 microgram estradiol patch, 1.25 mg CEE, 2mg oral estradiol Cyclical progestins, if intact uterus, 12 d/month DOT is until the natural age for menopauseQ" "What is the recommended length of duration for progesterone in POI treatment if the uterus is intact? - CORRECT ANSWER=> 12 days of the month" "What is the alternative treatment approach for menorrhagia in POI? - CORRECT ANSWER=> IUD plus estrogen patch" "When is continuous HRT considered in the treatment of POI? - CORRECT ANSWER=> When not wanting to risk pregnancy" "Hair loss. Difference between FPHL and telogen effluvium? - CORRECT ANSWER=> FPHL is gradual loss felt to be due to the altered estrogen:androgen ratio. Telogen effluvium is a sudden shedding felt to be due to a disruption of the hair cycle often following several months after a life stressor, chronic illness, beta blockers or anticoagulants- usually more patchy hair loss." "Describe the FPHL pattern. - CORRECT ANSWER=> Thinning at the crown of the head and widening of the hair part." "Treating FPHL - CORRECT ANSWER=> MINOXIDIL (only FDA approved option) Spironolactone/Finasteride (NOT FDA approved) Ketoconazole shampoo / Antidandruff shampoo" "What ethnicity has the least likely chance of having bad hot flashes? - CORRECT ANSWER=> Japanese"
Will not improve on steroids Screen for co-existing breast, GI or GU cancer. They are present 20-30% of the time." "Normal PVR. Abnormal PVR. - CORRECT ANSWER=> <100mL
200mL Between 100-200mL consider repeat testing on alternative day." "Systemic and vaginal estrogen will not help with this type of urinary incontinence? - CORRECT ANSWER=> Will NOT help with stress incontinence" "Which topical vaginal estrogen has the highest dose? - CORRECT ANSWER=> the vaginal rings FEMRING IS THE HIGHEST" "Most common cause of vulvovaginitis? - CORRECT ANSWER=> BV" "What postmenopausal condition is associated with burning and diffuse yellow/brown discharge and dyspareunia? Hint: it does not respond to local ET. How do you treat it? - CORRECT ANSWER=> Desquamative inflammatory vaginitis (DIV). Treat with clindamycin or hydrocortisone
- ET." "What hormones are associated with sexual desire in women? - CORRECT ANSWER=> circulating androgens" "Women who have had a BSO experience an abrupt and persistent decline in what hormone? - CORRECT ANSWER=> circulating androgen levels" "In DSMV, HSDD and FAD were combined into a single dysfunction called? - CORRECT ANSWER=> Female Sexual Interest/Arousal Disorder" "FDA approved HSDD treatment - CORRECT ANSWER=> flibanserin not yet: bremelanotide" "FGAD treatments (genital arousal disorder) - CORRECT ANSWER=> L-arginine, topical alprostadil, wellbutrin, oxytosin.
phosphodiesterase inhibitors-lacking in efficacy Eros therapy device $300- vaccum-like the penis pump" "FOD (orgasmic disorder) treatments - CORRECT ANSWER=> directed masturbation is most researched behavioral treatment." "What is true about cognition and surgical menopause - CORRECT ANSWER=> Memory for verbal information can be compromised immediately after surgical menopause, especially if it is before the typical age of menopause." "Meta analysis of RCTs have shown small benefit of what diet/exercise for global cognition and memory? - CORRECT ANSWER=> Mediterranean diet with olive oil as well as isoflavone supplements helps with memory; MD and Tai Chi exercise helps with global cognition." "effect of HRT on cognition - CORRECT ANSWER=> 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? - CORRECT ANSWER=> 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." "3 reasons supporting the idea that HRT in early menopause may decrease a woman's chance of developing alzheimer's disease? - CORRECT ANSWER=> 1. Observational studies imply it
- Clinical trial of transdermal estradiol during the early postmenopause stage is associated with reductions in AD pathology.
- 18 year cumulative follow up data from WHI found that women randomized to ET had significantly lower risk of dying from AD or dementia compared with women randomized to receive placebo." "Migraine headache and pregnancy - CORRECT ANSWER=> typically migraines improve-estrogen levels stabilize" "Migraine without aura after menopause - CORRECT ANSWER=> usually decrease with natural menopause"
"How does HRT impact gallbladder disease? - CORRECT ANSWER=> Increases risk of gallstones and reduces gallbladder motility with oral HRT, lower risk with transdermal." "When did they start screening blood for Hep C? - CORRECT ANSWER=> 1992, so women who have received blood products or organ transplants prior to 1992 may have acquired Hepatitis C" "Why do we screen for Hep C? - CORRECT ANSWER=> Most infections become chronic and most are asymptomatic until liver damage is detected years later. Our treatments are improving so if we catch this earlier in people, outcomes will be better." "Initially all adults born from what year to what year were recommended to receive one time Hep C testing? Since 2013, what age to what age is recommended to screen for NOT at risk patients? - CORRECT ANSWER=> 1945 to 1965; USPSTF recommends 18-79yo be tested once in their lifetime, unless higher risks necessitate additional testing" "Routine screening of all adults for Hepatitis C of what age group? - CORRECT ANSWER=> Per USPSTF 2020, recommended screening for all adults 18-79yoa. Consider increased screening in <18yoa if high risk, and more than once screening in adults with continued risk." "What HPV types are high risk (12)? Which two are responsible for most HPV-related cancers? - CORRECT ANSWER=> 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 16 & 18 are responsible for most HPV-related cancers" "By age 50y, what percentage of US women will have acquired a genital HPV infection? - CORRECT ANSWER=> 80% HPV is very common, and most clear it on their own" "What is the most commonly sexually transmitted infection in the US? - CORRECT ANSWER=> HPV" "What percentage of bone loss do women have from the menopause transition? - CORRECT ANSWER=> 10-12% on average, about 1 t score" "What T-score defines osteopenia? - CORRECT ANSWER=> -1.5 to -2.5" "What T-score defines osteoporosis? - CORRECT ANSWER=> < -2.5"
"What Z-score defines osteoporosis? When is Z-score used? - CORRECT ANSWER=> Z-score < 2. and a history of a fragility fracture, used in premenopausal women." "What races are at highest risk of osteoporosis? - CORRECT ANSWER=> White and hispanic populations" "What amount of women require long term care after hip fracture? What amount of women have long term loss of mobility after hip fracture? - CORRECT ANSWER=> 1 in 4 women (25%) require long term care 1 in 2 woemn (50%) have long term loss of mobility" "Asians have ____BMD than white people? - CORRECT ANSWER=> lower" "Black women have ____BMD than white people? - CORRECT ANSWER=> higher" "Over 3 servings of alcohol daily increases the risk for fracture by how much? - CORRECT ANSWER=> 38% for osteoporotic fracture and 68% for hip fracture" "What 4 ethnic specific versions of FRAX are there? - CORRECT ANSWER=> white, asiain, black, hispanic" "Dairy free diet amount of calicum. How much do they need to supplement? - CORRECT ANSWER=> dairy free diet-300mg calcium daily. Needs 800-1200mg" "Tibolone is used to treat ___? Where is it approved? Why wasn't it submitted for approval in the US and Canada? - CORRECT ANSWER=> Osteoporosis Approved in Mexico with decreased risk of vertebral and nonvertebral fractures noted. Increased risk of stroke" "Why was estrogen not approved for osteoporosis? - CORRECT ANSWER=> Decreased risk of vertebral and hip fracture in low fracture risk population, but estrogen has not been shown to decrease fracture risk in women with osteoporosis. More prevention than treatment." "Black box warning for PTH receptor agonists? - CORRECT ANSWER=> Osteosarcoma"
"Premenopause - CORRECT ANSWER=> Reproductive stage between menarche and onset of perimenopause" "FSH - CORRECT ANSWER=> Follicle Stimulating Hormone" "AMH - CORRECT ANSWER=> AntiMullerian Hormone" "InhB - CORRECT ANSWER=> Inhibin B" "E2 - CORRECT ANSWER=> Estradiol" "Classic Symptoms of Menopause (5) - CORRECT ANSWER=> Change in menstrual cycle Vasomotor symptoms (Night sweats / Hot flashes) Vulvovaginal symptoms (Dyspareunia, Change in pH) Sleep disturbance Psychological symptoms (Depression, Anxiety, Mood)" "Nontraditional Symptoms of Menopause (4) - CORRECT ANSWER=> Cognitive concerns Joint pain Dry eyes Change in weight distribution" "D3 FSH is helpful, when? - CORRECT ANSWER=> Only if elevated >10" "D3 E2 normal value? And what does it do in perimenopause? - CORRECT ANSWER=> <80pg/mL is considered a normal E2 level; in perimenopause it increases" "Describe the phases of the STRAW (Stage: -1) Late transition - CORRECT ANSWER=> The number of remaining oocytes drop below a critical level with sporadic follicular development resulting in sporadic ovulation. Lower progesterone levels are noted. Follicular development eventually stops which results in estradiol deficiency." "List the ethnic prevalence of POI in order from greatest to least for patients that are white, black, hispanic, Japanese, & Chinese. - CORRECT ANSWER=> Black/Hispanic 1.4%, White 1%, Chinese 0.5%, and Japanese 0.1%." "What is the cause of earlier mortality in women with surgical menopause <45? - CORRECT ANSWER=> CVD"
"Increased trunk-mass-to-leg-fat-mass ratio has been associated with what changes in vitals, and labs? - CORRECT ANSWER=> Increased blood pressure, fasting glucose, and abnormal lipoprotein profiles." "Women with increased visceral adipose tissue stores are more likely to suffer from what comorbidities? - CORRECT ANSWER=> Cardiometabolic conditions, DM, metabolic syndrome, hepatic statosis, and aortic plaques." "Obese, postmenopausal women have a _____ rate of breast cancer than postmenopausal women of normal weights. - CORRECT ANSWER=> Higher" "Obesity and VMS: Elevated BMI is associated with ____ frequent / _____ VMS during perimenopause. Higher BMI is associated with _____ VMS when women are postmenopausal. - CORRECT ANSWER=> more / severe fewer" "Obesity and hormone values: Obese premenopausal / perimenopausal women have _____ estradiol levels than non obese patients. Obese postmenopausal women have _____ estradiol levels than non obese patients. - CORRECT ANSWER=> Lower / High" "What are the effects of androgens on GU health? (2) - CORRECT ANSWER=> Simulates nerve fibers and maintains healthy epithelium" "Menopause is associated with what body composition changes? - CORRECT ANSWER=> Menopause is associated with increase in central adiposity as well as visceral fat and decrease of lean body mass." "What are the hormonal changes noted with sleep disurbance? - CORRECT ANSWER=> Increased cortisol, lower thyrotropin, lower leptin, reduced glucose tolerance" "List the risk factors for VMS (5) - CORRECT ANSWER=> 1) low socioeconomic status
- low education level
- obesity (in perimenopause)
- smoking/tobacco use
"How does lichen sclerosus and lichen planus appear? - CORRECT ANSWER=> As white plaques and papules or as erosive-appearing ulcerations, sometimes with fissuring." "How do you diagnose LS or LP? And what is the treatment recommended? - CORRECT ANSWER=> Diagnosed by biopsy and treatment is with high-potency topical steroids." "Vulvar Masses: Condyloma acuminatum are caused by what? How is it treated? - CORRECT ANSWER=> Condyloma acuminatum is caused by HPV infection. Treated with topical agents such as trichloroacetic acid, podophyllin, or imiquimod. If extensive, consider laser or excision with GYN ONC." "What are less common masses of the vulva? (5) - CORRECT ANSWER=> Hidradenomas, lipomas, fibromas, syringomas, and schwannomas." "What are the changes in the female that cause increased risk of postmenopausal UTI? - CORRECT ANSWER=> Increase in vaginal pH and changes in the microbiome." "What are additional risk factors, external to the postmenopausal changes, that increase a woman's risk of UTI? (4) - CORRECT ANSWER=> DM, incontinence, prolapse, increased PVR" "Why might you consider vaginal estrogen, after antibiotics for UTI in postmenopausal women?
- CORRECT ANSWER=> Vaginal estrogen restore pH, increases lactobacilli, and may improve immune response." "True or False? The WHI observational study revealed no increased risk of endometrial cancer, breast cancer, or CVD with vaginal ET use. - CORRECT ANSWER=> TRUE. No increased risk noted for vaginal ET use." "Estradiol ring is FDA approved for the treatment of, what? - CORRECT ANSWER=> Urinary Urgency" "CE and estradiol are approved for the treatment of VVA and dyspareunia. What are the approved doses? - CORRECT ANSWER=> CE VVA: 0.5-2g/day (21d on / 7d off) dyspareunia: 0.5g/twice weekly or 0.5g/day (21d on / 7d off) 17β-estradiol cream
VVA 2-4g/day for 1-2wks; then 1g 3x/wk" "In women with HT contraindications, which treatment is generally preferred, and why? - CORRECT ANSWER=> Estradiol vaginal tablets or low-dose estradiol vaginal rings are generally preferred to the use of creams because of their fixed-dosing and lack of significant systemic absorption." "Due to the theoretical risk of endometrial hyperplasia from local absorption of low-dose vaginal ET, in which patients would you consider addition of progestogen? - CORRECT ANSWER=> Obese patients. Generally, progestogens are not indicated." "PALM-COEIN - CORRECT ANSWER=> P: Polyp A: Adenomyosis L: Leiomyoma M: Malignancy/hyperplasia C: Coagulopathy O: ovulatory dysfunction E: Endometrial I: Iatrogenic N: Not yet classified" "Female Sexual Dysfunction is separated into what (3) categories in DSMV? - CORRECT ANSWER=> Desire/Arousal: FSIAD Pain: Genito-Pelvic Pain/Penetration Disorder Orgasm: Female Orgasmic Disorder" "Treatments for FSD - CORRECT ANSWER=> Psychotherapy Pharmacotherapy (low-dose vaginal estrogen) Vibrator Therapy PFPT Flibanserin Bremelanotide Testosterone** (Off-label)" "Hormone Effects on Vaginal Tissue - CORRECT ANSWER=> Enhances skin sensation. Also increases vaginal lubrication and elasticity."
"What are the BMD Testing Recommendations? - CORRECT ANSWER=> USPSTF: -All women >65y/o -Women <65y/o if FRAX score for 10y risk is >8.4% -Perimenopausal women at high risk for fracture" "When is drug therapy needed for osteoporosis? - CORRECT ANSWER=> History of vertebral, hip, fragility, or other low-trauma fracture. T-score <-2. 10y FRAX >20% or hip fracture risk >3%" "What ages is the FRAX risk assessment appropriate for? - CORRECT ANSWER=> Postmenopausal women aged 40-90y" "What is the appropriate dose of Vit D and Calcium for PRIMARY PREVENTION OF FRACTURE? - CORRECT ANSWER=> Vit D 400IU and Calcium 1000mg" "After 5yrs of bisphosphonate therapy in high-risk women, what additional treatment(s) should you consider and why? - CORRECT ANSWER=> Denosumab (RANK ligand inhibitor) for the additional gains in BMD. Similarly, switching from bisphosphonate to teraparatide (PTH receptor agonist) results in additional gains in spine BMD and hip." "What is the single most important preventable risk factor for CVD in women? - CORRECT ANSWER=> Smoking. A woman who smokes is 2-6x more likely to have a heart attack than a woman who does not smoke." "Does the AHA or NAMS recommend HT for the primary or secondary prevention of CVD? - CORRECT ANSWER=> NO." "According to AHA, what are the four initial drug classes for management of HTN, in adults who do not have a compelling need for a specific BP-lowering medication? - CORRECT ANSWER=> Thiazide diuretics, CCB, ARBs, ACE-i" "What is the dose recommendations for high-intensity statin therapy for atorvastatin and rosuvastatin? - CORRECT ANSWER=> Atorvastatin (40)-80mg Rosuvastatin (20)-40mg" "Metabolic syndrome is also associated with what (3) conditions? - CORRECT ANSWER=> Steatohepatitis, CKD, and PCOS"
"LADA (latent autoimmune diabetes of adulthood) can be diagnosed by measuring what two antibodies? - CORRECT ANSWER=> Anti-glutamic acid decarboxylase antibody and zinc transporter-8" "In the WHI, women receiving HT had a ____ % reduction in the development of ____. This was also seen in a USPSTF systematic review. - CORRECT ANSWER=> 14-19% reduction in the development of DM in postmenopausal women treated with HT." "Is it recommended to use HT to reduce risk of MetS or DM? - CORRECT ANSWER=> No, it is not recommended." "What diabetic medications reduce CVD risk in persons with known CVD? - CORRECT ANSWER=> empaglifozin (Jardiance) & canagliflozin (Invokana) liraglutide (Victoza) & semaglutide (Ozempic)" "FDA defines food as: - CORRECT ANSWER=> food or drink for man or animal; chewing gum; articles used for components of such item" "FDA defines drug as: - CORRECT ANSWER=> articles recognized in the US pharmacopeia, homeopathic pharmacopeia, or national formulary; articles intended for use in the diagnosis, cure, and mitigation, treatment, and prevention of disease in man or animal; articles (OTHER THAN FOOD) intended to affect the structure/function of the body of man or animal" "DSHEA - CORRECT ANSWER=> Dietary Supplement Health & Education Act" "DSHEA and FDA, who is responsible for substantiating claims? - CORRECT ANSWER=> DSHEA does not prevent the FDA from determining a dietary supplement is a drug, but it does restrict the power of the FDA to regulate the quality of dietary supplements and limits intervention when a potential safety issue arises. The manufacturer is responsible for substantiating claims about their product with adequate evidence to show they are not false or misleading." "In the US, what is a good QC indicator in manufacturing regarding dietary supplements? - CORRECT ANSWER=> USP and NSF (national sanitation foundation)" "Which dietary supplement & vitamin are not recommended by the USPSTF based on their increased cardiovascular and cancer risks? - CORRECT ANSWER=> beta-carotene and Vit E"
