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NAMs Menopause Certification Exam questions and
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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 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
- 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 transition (-1) FSH level on random draw - ✅✅25 or higher Black women have higher or lower FSH levels? - ✅✅Higher Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic women? - ✅✅lower Menopause transition-changes in SHBG and testosterone? ratio? - ✅✅SHBG decreases Testosterone/SHBG ratio increases by 80%. Testosterone/SHGB ratio is called what? - ✅✅The free androgen index What stage are VMS more likely? - ✅✅+1b (generally last 2 years) What hormone is generally higher in obese women? - ✅✅Estrone-via aromatization. The postmenopausal ovary continues to produce what two hormones? - ✅✅testosterone and androstenedione Surgical menopause causes women to have lower levels of what hormone? - ✅✅testosterone. 40-50% lower than in women w/ intact ovaries.
Cortisol and HRT - ✅✅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? - ✅✅No, cortisol levels have NOT been associated with more severe VMS. Local DHEA has been proven to help with what? - ✅✅vaginal pain and dyspareunia How to DX POI? - ✅✅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 - ✅✅prolactin FSH estradiol TSH pregnancy test treatment of POI - ✅✅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? - ✅✅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 - ✅✅thinning at the crown of the head and widening of the hair part Treating FPHL - ✅✅MINOXIDIL spironolactone
most common type of vulvar cancer - ✅✅squamous cell carcinoma Vulvar disorder commonly misdiagnosed as eczema or dermatitis? - ✅✅paget's disease will not improve on steroids screen for co-existing breast, GI or GU cancer. They are present 20-30% of the time. Normal PVR - ✅✅<100mL systemic and vaginal estrogen will not help with this type of urinary incontinence?
- ✅✅will NOT help with stress incontinence. Which topical vaginal estrogen has the highest dose? - ✅✅the vaginal rings FEMRING IS THE HIGHEST Most common cause of vulvovaginitis? - ✅✅BV post menopause burning and diffuse yellow/brown discharge and dyspareunia that does not respond to local ET? - ✅✅desquamative inflammatory vaginitis. treat different with clindamycin or hydrocortisone+ET What hormones are associated with sexual desire in women? - ✅✅circulating androgens
Women who have had a BSO experience an abrupt and persistent decline in what hormone? - ✅✅circulating androgen levels HSDD and FSAD were combined into a single dysrunction called - ✅✅female sexual interest/arousal disorder HSDD treatments - ✅✅flibanserin and bremelanotide FGAD treatments (genital arousal disorder) - ✅✅L-arginine, topical alprostadil, wellbutrin, oxytosin. phosphodiesterase inhibitors-lacking in efficacy Eros therapy device $300- vaccum-like the penis pump FOD (orgasmic disorder) treatments - ✅✅directed masturbation is most researched behavioral treatment. Does systemic ET cause fibroids to resume growth? - ✅✅Rarely. They often shrink after menopause. What is true about cognition and menopause? - ✅✅Difficulty concentrating and remembering are common. What is true about cognition and surgical menopause - ✅✅memory for verbal information can be compromised immediately after surgical menopause, especially if it is before the typical age of mesopause.
Migraine headache and pregnancy - ✅✅typically migraines improve-estrogen levels stabilize Migraine without aura after menopause - ✅✅usually decrease with natural menopause menstrual migraine after menopause - ✅✅should resolve completely When to consider preventative medication for migraines - ✅✅>2 times per week or severe and effecting QOL Triptans are contraindicated in what? - ✅✅patients with cardiovascular disease, as are NSAIDs Menstrual migraine treatment - ✅✅NSAID or triptan 2 days before expected to get your period, and take for 5-7 days. cdc and who guidelines for migraine treatment - ✅✅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? - ✅✅it can take several months. what is th emost common form of arthritis? - ✅✅osteoarthritis
what areas of th ebrain have th emost estrogen receptors? - ✅✅hippocampus and prefrontal cortex what is the most common thyroid disorder in women? - ✅✅hashimoto thyroiditis if a patient on levothyroxine is started on estrogen, when do you recheck and what can you anticipate happening? - ✅✅recheck 6-8 weeks later. anticipate that the dose of levothyroxine may need to be increased. oral estrogens increase thyroid binding globulin which in turn reduces the levels of free T4. when is treatment of subclinical hypothyroidism recommended? - ✅✅when the TSH level is higher than 10. are hot or cold thyroid nodules typically most likely to be malignant? - ✅✅cold nodules how does HRT impact gallbladder disease? - ✅✅increases risk of gallstones with oral HRT, lower risk with transdermal. when did they start screening blood for hep c? - ✅✅1992, so women who have received blood products or organ transplants prior to 1992 may have acquired heptatitis c
what z score defines osteoporosis before menopause? - ✅✅z score less than 2.0 and a history of a fragility fracture Who is at highest risk of osteoporosis? - ✅✅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? - ✅✅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? - ✅✅lower Black women have ____BMD than white people? - ✅✅higher Over 3 servings of alcohol daily and risk for fracture? - ✅✅38% for osteoporotic fracture and 68% for hip fracture What 4 ethnic specific versions of FRAX are there? - ✅✅white, asiain, black, hispanic Dairy free diet amount of calicum. How much do they need to supplement? - ✅✅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? - ✅✅approved in mexico decreased risk of vertebral and nonvertebral fracture increased risk of stroke Why was estrogen not approved for osteoporosis? - ✅✅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? - ✅✅osteosarcoma caution using PTH receptor agonists in what condition? - ✅✅hypercalcemia when would you use PTH receptor agonists? - ✅✅someone incredibly high risk for vertebral fracture raloxifene helps with what kind of fractures? - ✅✅vertebral fractures raloxifene risk factors - ✅✅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? - ✅✅1 in 1000 after 2- 3 years.
