Download NAMs Menopause Certification Exam Verified Questions with Approved Answers Latest 2025 and more Exams Nursing in PDF only on Docsity!
Obese women and estradiol levels during menopause - ANSWER 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 - ANSWER These ethnic groups have lower estradiol levels then white, black and hispanic women. stage +2 - ANSWER late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary symptoms. Stages +1a, +1b, +1c - ANSWER early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate. Elevated FSH, LH - ANSWER Endocrine labs after menopause AMH, inhibin B - ANSWER These hormones work during reproductive years to not deplete follicle pool too quickly. Phases during menopause transition and PMS symptoms - ANSWER Menstrual cycle variable, persistent >7 day difference between difference in length of consecutive cycles. How to respond if a patient requests FSH lab? - ANSWER 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. - ANSWER AMH DHEA (dehydroepiandrosterone) - ANSWER 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 - ANSWER Vagina, vulva, urethra, trigone of the bladder Effects of estrogen on tissue - ANSWER 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 - ANSWER Thinning, loss of elasticity, loss or absence or rugae. Vagina and urethra in menopause - ANSWER vagina narrows, urethra moves closer to the introitus. Stress urinary incontinence - ANSWER Vaginal estrogen and urinary incontinence: what type does it help with? Treatment for FPHL - ANSWER Minoxidil, spironolactone, finasteride, estrogen therapy Late reporoductive years - 3b and - 3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? - 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? and why? - 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? - 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. AFC - ANSWER Antral follicle count Number of follicles that are detectable with ultrasound. They are sensitive to FSH and considered to represent the availability pool of follicles. Late menopause transition (-1) FSH level on random draw - ANSWER 25 or higher
Androstenedione. Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors. - ANSWER Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by the anterior pituitary. What part of the pituitary gland secretes adrenocorticotropic hormone? - ANSWER Anterior pituitary. The posterior only secretes vasopressin and oxytosin. Climacteric phase - ANSWER The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of menopause. Early menopause - ANSWER LMP before age 45 Late menopause - ANSWER LMP after age 54 Primary ovarian insufficiency - ANSWER Menopause that occurs before age 40 Early menopause transition (stage - 2) - ANSWER Persistent difference of 7 days or more in the length of consecutive cycles. Late menopause transition (stage - 1) - ANSWER 60 or more consecutive days of amenorrhea Luteal out of phase event (LOOP) - ANSWER 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. Cortisol and HRT - 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? - ANSWER No, cortisol levels have NOT been associated with more severe VMS. Local DHEA has been proven to help with what? - ANSWER vaginal pain and dyspareunia How to DX POI? - ANSWER Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months. AND elevated FSH over 25 on two occasions at least 4 weeks apart. Anyone <40years old who misses 3+ consecutive cycles gets these labs - ANSWER prolactin FSH estradiol TSH pregnancy test treatment of POI - ANSWER 100 microgram estradiol patch 1.25 mg CEE 2mg oral estradiol If intact uterus-progesterone for 12 days of the month. Physiologic is better than continuous hormonal contractption, but if menorrhagia-IUD plus estrogen patch, or if really not wanting to risk pregnancy, continuous HRT can be used. Hair loss. Difference between FPHL and telogen effluvium? - ANSWER FPHL is gradual, telogen effluvium is sudden and usually precipitated by a life stressor, chronic illness, beta blockers or anticoagulants-usually more patchy hair loss. FPHL pattern - ANSWER thinning at the crown of the head and widening of the hair part Treating FPHL - ANSWER MINOXIDIL spironolactone finasteride What ethnicity has the least likely chance of having bad hot flashes? - ANSWER Japanese
What hormones are associated with sexual desire in women? - ANSWER circulating androgens Women who have had a BSO experience an abrupt and persistent decline in what hormone? - ANSWER circulating androgen levels HSDD and FSAD were combined into a single dysrunction called - ANSWER female sexual interest/arousal disorder HSDD treatments - ANSWER flibanserin and bremelanotide FGAD treatments (genital arousal disorder) - 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 - ANSWER directed masturbation is most researched behavioral treatment. Does systemic ET cause fibroids to resume growth? - ANSWER Rarely. They often shrink after menopause. What is true about cognition and menopause? - ANSWER Difficulty concentrating and remembering are common. What is true about cognition and surgical menopause - ANSWER memory for verbal information can be compromised immediately after surgical menopause, especially if it is before the typical age of mesopause. Meta analysis of RCTs have shown small benefit of what diet/exercise for global cognition and memory? - ANSWER Mediterranean diet with olive oil and tai chi exercise helps with global cognition Mediterranean diet with olive oil and isoflavone supplements helps with memory. effect of HRT on cognition - 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? - 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? - 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 - ANSWER typically migraines improve-estrogen levels stabilize Migraine without aura after menopause - ANSWER usually decrease with natural menopause menstrual migraine after menopause - ANSWER should resolve completely When to consider preventative medication for migraines - ANSWER >2 times per week or severe and effecting QOL Triptans are contraindicated in what? - ANSWER patients with cardiovascular disease, as are NSAIDs Menstrual migraine treatment - ANSWER NSAID or triptan 2 days before expected to get your period, and take for 5-7 days. cdc and who guidelines for migraine treatment - ANSWER migraine with aura-advise to not use combined hormone contraception caution in women with migraine without aura How long can it take for arthralgia from vitamin d deficiency or hypothyroidism to fully resolve? - ANSWER it can take several months. what is th emost common form of arthritis? - ANSWER osteoarthritis what areas of th ebrain have th emost estrogen receptors? - ANSWER hippocampus and prefrontal cortex
ANSWER 10 - 12% on average, about 1 t score What t score defines osteopenia - ANSWER - 1.5 to - 2. what t score defines osteoporosis - ANSWER less than - 2. what z score defines osteoporosis before menopause? - ANSWER z score less than 2.0 and a history of a fragility fracture Who is at highest risk of osteoporosis? - 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? - 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? - ANSWER lower Black women have ____BMD than white people? - ANSWER higher Over 3 servings of alcohol daily and risk for fracture? - ANSWER 38% for osteoporotic fracture and 68% for hip fracture What 4 ethnic specific versions of FRAX are there? - ANSWER white, asiain, black, hispanic Dairy free diet amount of calicum. How much do they need to supplement? - ANSWER dairy free diet-300mg calcium daily. Needs 800-1200mg Tibolone and osteoporosis where is it approved? why wasn't it submitted for approval in the US and canada? - ANSWER approved in mexico decreased risk of vertebral and nonvertebral fracture increased risk of stroke Why was estrogen not approved for osteoporosis? - 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? - ANSWER osteosarcoma
caution using PTH receptor agonists in what condition? - ANSWER hypercalcemia when would you use PTH receptor agonists? - ANSWER someone incredibly high risk for vertebral fracture raloxifene helps with what kind of fractures? - ANSWER vertebral fractures raloxifene risk factors - ANSWER increased risk of death from stroke in high risk patients, estrogen like risk of VTE, worsens hot flashes atypical femur risk in women on bisphosphonate? - ANSWER 1 in 1000 after 2-3 years. Salmon calcitonin and osteoporosis? - ANSWER small increase in spine BMD. daily SQ injections or nasal. Implications of estrogen drop on skin during menopause - ANSWER Decreased fibroblast activity disrupted elastin decreased GAG production Disrupted melanocyte regulation Decreased blood flow and cellular oxygenation effects on keratinocytes Disruption of cellular growth factors and repair enzymes accelerated lipoatrophy Fat pad modification Bone resorptuon Definition of stress incontinence - ANSWER Involuntary loss of urine that occurs with an activity such as coughing or sneezing that increases intraabdominal pressure. Leakage is in drops, usually 2/2 to poor urethral support, urethral sphincter weakness, dysfunction of pelvic floor Definition of urgency incontinence - ANSWER Involuntary loss of urine preceded by sensation of urgency to urinate. Generally associated with losses of larger volumes of urine that soak through pads and clothing. Leakage results from detrusor (bladder) overactivity/uninhabited contractions of detrusser Definition of mixed incontinence - ANSWER includes stress and urgency
GnRH therapy for fibroids - ANSWER Addback therapy can be used to protect against VMS and bone mineral density losss Nonsurgical treatment of fibroids - ANSWER Tranexamic acid and mefenamic acid mirena GnRH Selective progesterone receptor modulators Uterine artery embolization Hysteroscopic myomectomy is most suitable for fibroids smaller than - ANSWER 5cm in diameter Lichen Planus - ANSWER Pruritic, purple, polygonal planar papules and plaques ( P's) Lichen sclerosis et atrophicus - ANSWER inflammatory condition - autoimmune - antibodies against extracellular matrix. Affects males and females equally - but female genital and perineal region is most commonly affected. Lichen Simplex Chronicus - ANSWER Leukoplakia with thick, leathery vulvar skin associated with chronic irritation and scratching., hyperplasia of the vulvar squamous epithelium lichen planus treatment - ANSWER only when it is symptomatic, these respond to topical corticosteroids. When it has a burning sensation, patients should be prescribed an antifungal lichen sclerosis tx - ANSWER topical steroid (clobetasol) Lichen Simplex Chronicus Treatment - ANSWER Corticosteroid: Triamcinolone 0.1% (Alway start off with low potency then move if it gets worst) Non-pharmo Tx for restless legs and periodic imb movements - ANSWER Remove potential aggravators such as sleep deprivation, alcohol, exercise, caffeine, smoking Sleep hygiene, exercise, warm baths, leg vibration, massage, acupuncture, passive strestching PHarmo tx for RLS - ANSWER Parmipexole and ropinirole Red flags for headache - ANSWER Systemic symptoms (fever, weight loss, rash) Systemic illness malignancy, immunosupression Neurologic symptoms and/or signs in consciousness Sudden/abrupt onset
new onset or progressive New/different from previoux headache hx Abortive therapy for migraine - ANSWER triptans, NSAIDs Preventative therapy for migraines - ANSWER Beta Blockers (propranolol) , Antiepileptic Drugs (divalproex), Tricyclic Antidepressants (amitriptyline) Hormone therapy for headache - ANSWER CAn be used to mitigate falling estrogen levels, no product FDA approved; can add lowdose estrogen supplement during w/d phase of ocp, use continuous HT; if progesterogen causes, switch to micronized What to consider when evaluating women with arthralgia - ANSWER 2/2 to menopause 2/2 to arthritis 2/2 to other rheumatologic condition Causes of myalgia - ANSWER drug induced (statines, fibrates) endocrine (vit D deficiency, thyroid, cushings) Menopause plymyalgia rheumatica Causes of bone pain - ANSWER metagolic (pagets disease) neoplasia (multiple myeloma, metastatic infections fracture Perimenopause STRAW staging - ANSWER - 2 to +1a; STRAW staging system - ANSWER POI - ANSWER Loss of ovarian follicular activity prior to the age of 40 Prevalence of POI in US - ANSWER 3% T/F Premature menopause is a risk factor for CAD - ANSWER True
- higher risk for abdominal adiposity, dm, dyslipidemia Etiology of premature menopause - ANSWER 1) Iatrogenic/Indused (surgery, chemotherapy, cystectomy, hysterectomy, radiation)
- spontaneous (genetic disorders, x-chromosome disorder (monosomy, trisomy); specific mutations: POF1, POF2, FMR genes
- autoimmune causes: polyendocrine syndromes, other endocrinopathies, nonendocrine auto-immune conditions
Weight gain during menopausal transition - ANSWER 2 - 4 fold increase in fat mass (6%, 1.6kg over 3.5 years .5% loss of lean muscle Changes in weight gain during peri/meno - ANSWER Premenopaust weight increase,MT - stead increase, post meno no change Should calorie intake decrease in post menopause - ANSWER yes likely driven by decreased active energy expenditure HRT on cardiovascular risk factors - ANSWER IN women w/o DM, HRT (oral or transdermal E+/-P) improves lean body mass, reduces abdominal adiposity, improves insulin resistance, improves lipids, decreases BP When to add anti-obesity medication - ANSWER Initiate weight loss medication as adjunct to lifestyle:
- if BMI (27-29.9 in presence of comorbid)
- If BMI >30 and failure of lifestyle Weight loss w/ orlistat - ANSWER ~8% GI lipase inhibitor poop in your pants Weight loss with phentermine/topiramate ER - ANSWER 8 - 12% C/I: glaucoma, hyperthyroid, MAOI SE: insomnia, dry mouth, paresthesias, metabolic acidocis, anxiety, tachy Weight loss with Naltrexone SR/Bupropion SR (Contrave) - ANSWER ~5-6.4% Dopamine and norepinephrine reuptake inhibitor and u-opioid receptor antagonist C/I: htn, seizures, eating disorder, opioid use, SE: nausea, headache Weight loss with liraglutide - ANSWER GLP-1 receptor agonist Dose up to 3mg daily in .6mg steps Weight loss ~7-10% C/I: pancreatitis, fam hx of medullary thyroid, multiple endocrine neoplasia S/E: nausea, diarrhea, vomiting constipation Weight loss with semaglutide - ANSWER ~14-16% GLP-1 receptor agonist Dose up yo 2.4mg daily in slow weekly dose titration C/I: pancreatitis, fam hx of medullary thyroid, multiple endocrine neoplasia
S/E: nausea, diarrhea, vomiting constipation How do GLP-1 receptor agonists work? - ANSWER GLP-1s help the pancreas release more insulin, delay stomach emptying, and reduce appetite. Weight loss with pentermine monotherapy - ANSWER Short term, FDA approved for shortterm use (<12 weeks); common practice to prescribe for longer; retrospective data suggests; better weight loss iwth longer use >6m; no increase in AE cardiovascular; no addiction potential I do not believe any of theis Surgical management of obesity - ANSWER Roux-en-y bypass Sleeve gastrectomy Biliopancreatic diversion iwth duodenal switch Who is eligible for bariatric surgery? - ANSWER BMI > BMI >35 w/ 1 comorbid BMI 30-35 w/ T2DM, poor glycemic control despite lifestyle Non-scarring alopecia - ANSWER Disorders that reduce or slow hair growth without irreparably damaging the hair follicle
- primarily affect the hair shaft scarring alopecia - ANSWER replacement of hair follicles with scar tissue examples of non-scarring alopecia - ANSWER Androgenetic alopecia Telogen Effluvium Alopecia Areata How to treat scarring alopecia - ANSWER Send to derm Androgenetic alopecia - ANSWER Female pattern thinning Genetic predisposition Hromonal factors A slow minaturization over time
- follicular miniturization - finer hair
- shorter growth cycle - shorter hair
- longer latent period - delay before new hair starts NOT AN ABRUPT SHED Female pattern thinng: Who when what - ANSWER 50+% of women Can begin in teens
and bladder trigone non-pharmacologic vaginal moisturizer - ANSWER long term aid to vaginal dryness attaches to mucin and epithelial cells on vaginal wall Carries up to 60x its weight in water HOlds water in place requires maintenance 2-3x week What uterine cancer can you use topical estrogen? Which to not? - ANSWER Can: Type I and II Carcinosarcom a Cannot: Leiomyosarcoma Stromal sarcoma Which ovarian cancer can you use topical estrogen? Which can you not? - ANSWER Can: HGSOC Germ cell Granulosa cell Which types of cervical cancer can ou use topical estrogen - ANSWER All Dosing of vaginal estrogen - ANSWER daily for 2 weeks then 2x weekly Evaluation of incontinence - ANSWER Type:
- provoking factord
- sense of urgency
- Frequency
- Ability to defer Severity and Impact on QoL
- Leak frequency
- Pad use
- Impact on ADL Complexity & Safety Cannot: Endometrioid
- Bladder emptying
- Blood, stones
- Pain
- Comorbidities Main types of incontinence - ANSWER Stress incontinence Overactive bladder Oveflow incontinence Screening for thyroid disease - ANSWER Every 5 years starting at age 35 Most common thyroid disease - ANSWER Hypothyroidism caused by hashimoto thyroiditis Normal range of serum TSH - ANSWER .4 mIU/L to 4.5 mIU/L; if TSH level is elevated, free T4 and antithyroperoxidase antibodies should be measured Levo dosing - ANSWER 1.6ug per KG Over 50 start w/ 25ug to 50 with progression every 2-3 weeks until euthyroid is reached Wtih CHD start lower titrate every 6-8 weeks Monitor TSH every 4-6 weeks after any change If patient is treated with thyroid medication starts oral ET; what do yo u need to do and why? - ANSWER TSH levels should e monitored 6-8 weeks later; anticipate that dose of Levo may need to e increased; oral (not transdermal) estrogens increase thyroid binding globuling which reduces FT hyperthyroidism/ grave's disease - ANSWER abnormally high secretion of thyroid hormones Low TSH (persistently less than .1mIU/L in all persons aged 65 and older Bone effects of TSH - ANSWER 3 fold increase in hip fractures for pt iwth excess endogenous thyroid hormone production (i.e. TSH <.1mIU/L) hot thyroid nodule - ANSWER Rarely associated with thyroid cancer Definition of insomnia - ANSWER Sleep complaint that occurs at least 3 times per week for at least 3 months and is associated with distress or impaired daytime personal functioningS Screening tool for eating disorder - ANSWER SCOFF
