NAMS Menopause Certification Exam 2024: Comprehensive Study Guide with Detailed Answers, Exams of Nursing

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NAMS MENOPAUSE CERTIFICATION EXAM 2024 WITH 2

VERSIONS EACH WITH 1 2 0 QUESTIONS AND CORRECT

DETAILED ANSWERS LATEST UPDATE

1. Climacteric phase: The period of endrocrinologic, somatic, and transitory psychologic

changes that occur around the time of menopause.

2. Early menopause: LMP before age 45

3. Late menopause: LMP after age 54

4. Primary ovarian insufficiency: Menopause that occurs before age 40

5. Early menopause transition (stage - 2): Persistent difference of 7 days or more in the

length of consecutive cycles.

6. Late menopause transition (stage - 1): 60 or more consecutive days of amenorrhea

7. 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.

8. 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)

9. Chinese and Japanese women: These ethnic groups have lower estradiol levels then

white, black and hispanic women.

10. stage +2: late menopause stage: 5-8 years after FMP. Somatic aging predominates.

Increased genitourinary symptoms.

11. Stages +1a, +1b, +1c: early post menopause: 2 years after FMP. FSH rises, estradiol

decreases. VMS predominate.

12. Elevated FSH, LH: Endocrine labs after menopause

13. AMH, inhibin B: These hormones work during reproductive years to not deplete follicle

pool too quickly.

14. 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.

15. 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.

16. The potentially superior marker of menopause, a lab.: AMH

17. DHEA (dehydroepiandrosterone): Adrenal androgens: precursor hromones produced

by the adrenal gland that are enzymatically converted to active androgens or estrogens in peripheral tissues.

18. Location of estrogen receptors: Vagina, vulva, urethra, trigone of the bladder

19. Effects of estrogen on tissue: maintain blood flow, the collagen, and HA within the

epithelial surfaces. Supports microbiome and protects tissue from pathogens.

20. Vaginal changes with menopause: Thinning, loss of elasticity, loss or absence or rugae.

21. Vagina and urethra in menopause: vagina narrows, urethra moves closer to the

introitus.

22. Stress urinary incontinence: Vaginal estrogen and urinary incontinence: what type does

it help with?

23. Treatment for FPHL: Minoxidil, spironolactone, finasteride, estrogen therapy

24. 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.

25. 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. 26. 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.

27. 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.

28. Late menopause transition (-1) FSH level on random draw: 25 or higher

29. Black women have higher or lower FSH levels?: Higher

30. Chinese and Japanese women have higher or lower estradiol levels compared to

white, black and hispanic women?: lower 31 Menopause transition-changes in SHBG and testosterone? ratio?: SHBG decreases Testosterone/SHBG ratio increases by 80%.

32. Testosterone/SHGB ratio is called what?: The free androgen index

33. What stage are VMS more likely?: +1b (generally last 2 years)

34. What hormone is generally higher in obese women?: Estrone-via aromatization.

35. The postmenopausal ovary continues to produce what two hormones?: testosterone

and androstenedione

36. Surgical menopause causes women to have lower levels of what hormone?:

testosterone. 40-50% lower than in women w/ intact ovaries.

37. Driving piece of menopause is ovarian follicles depleting. What does this do to the

inhibin B and AMH?: inhibin and AMH decrease therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished follicle pool.

38. In the menopause transition, women spend more time in what phase?: Luteal-more

PMS symptoms, more frequent menstrual periods.

39. HPO axis theory and the menopause transition: It is felt that the HPO axis may become

less sensitive to estrogen, so even with good follicle growth and estradiol secretion, LH surges can fail which can lead to more cycle irregularity.

40. In the first year after the FMP, there is no production of what hormone?: progesterone

41. What region of the adrenal gland secretes the androgens?: zona reticularis 42. what

are considered the 'adrenal androgens'?: DHEA, DHEAS, Androstenedione.

43. Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by

3 main factors.: Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by the anterior pituitary.

44. What part of the pituitary gland secretes adrenocorticotropic hormone?: Anterior

pituitary. The posterior only secretes vasopressin and oxytosin.

45. 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.

46. Do cortisol levels associate with VMS severity?: No, cortisol levels have NOT been

associated with more severe VMS.

47. Local DHEA has been proven to help with what?: vaginal pain and dyspareunia

48. 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.

49. Anyone <40years old who misses 3+ consecutive cycles gets these labs-

: prolactin FSH estradiol TSH pregnancy test

50. 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.

51. 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.

52. FPHL pattern: thinning at the crown of the head and widening of the hair part 53.

Treating FPHL: MINOXIDIL

spironolactone finasteride

54. What ethnicity has the least likely chance of having bad hot flashes?: Japanese

55. What ethnicity is the most likely to have bad hot flashes?: black more frequent,

longer duration. 56 Median length of hot flashes: 10 years, early menopause transition women have them the longest.

57. Theories about etiology of hot flashes (6): lower ovarian estradiol thermoregulation zone

is narrowed neurokinins-regulate GnRH secretion. KNDy new meds serotonin cortisol and HPI axis dysregulation endothelial dysfunction.

58. VIN low grade-what to do high grade-what to do

differentiated VIN-what to do: low grade is not precancerous high grade is precancerous-GYN ONC differentiated-wide local excision-high risk of invasive carcinoma.

59. most common type of vulvar cancer: squamous cell carcinoma

60. 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.

61. Normal PVR: <100mL

62. systemic and vaginal estrogen will not help with this type of urinary incontinence?:

will NOT help with stress incontinence.

63. Which topical vaginal estrogen has the highest dose?: the vaginal rings

FEMRING IS THE HIGHEST

64. Most common cause of vulvovaginitis?: BV

65. 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

66. What hormones are associated with sexual desire in women?: circulating androgens

67. Women who have had a BSO experience an abrupt and persistent decline in what

hormone?: circulating androgen levels

68. HSDD and FSAD were combined into a single dysrunction called: female sexual

interest/arousal disorder

69. HSDD treatments: flibanserin and bremelanotide

70. 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

71. FOD (orgasmic disorder) treatments: directed masturbation is most researched

behavioral treatment.

72. Does systemic ET cause fibroids to resume growth?: Rarely. They often shrink after

menopause.

73. What is true about cognition and menopause?: Difficulty concentrating and

remembering are common.

74. 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.

75. Meta analysis of RCTs have shown small benefit of what diet/exercise for global

cognition and memory?: Mediterranean diet with olive oil and tai chi exercise helps with global cognition Mediterranean diet with olive oil and isoflavone supplements helps with memory.

76. effect of HRT on cognition: small or no overall effect on cognition

77. What HRT can increase your risk for dementia based on the WHIMS study in 65+ year

old healthy women?: 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 78. 3 reasons supporting the idea that HRT in early menopause may decrease a woman's chance of developing alzheimer's disease?: 1. Observational studies imply it

2. Clinical trial of transdermal estradiol during the early postmenopause stage is

associated with reductions in AD pathology.

3. 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.

79. Migraine headache and pregnancy: typically migraines improve-estrogen levels

stabilize

80. Migraine without aura after menopause: usually decrease with natural menopause

81. menstrual migraine after menopause: should resolve completely

82. When to consider preventative medication for migraines: >2 times per week or

severe and effecting QOL 83 Triptans are contraindicated in what?: patients with cardiovascular disease, as are NSAIDs

84. Menstrual migraine treatment: NSAID or triptan 2 days before expected to get your

period, and take for 5-7 days.

85. cdc and who guidelines for migraine treatment: migraine with aura-advise to not use

combined hormone contraception

caution in women with migraine without aura

86. How long can it take for arthralgia from vitamin d deficiency or hypothyroidism to

fully resolve?: it can take several months.

87. what is th emost common form of arthritis?: osteoarthritis

88. what areas of th ebrain have th emost estrogen receptors?: hippocampus and

prefrontal cortex

89. what is the most common thyroid disorder in women?: hashimoto thyroiditis 90. 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.

91. when is treatment of subclinical hypothyroidism recommended?: when the TSH

level is higher than 10.

92. are hot or cold thyroid nodules typically most likely to be malignant?: cold nodules

93. how does HRT impact gallbladder disease?: increases risk of gallstones with oral HRT,

lower risk with transdermal.

94. 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

95. why do we screen for hep C?: 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

96. all adults born from what year to what year should recieve one time hep c testing?:

1945 to 1965

97. routine screening of all adults for hepatitis c. is it reocmmended?: routine screening

for all adults is not recommended, however baby boomers are at the highest risk. infection rates are 5x other birth cohorts.

98. what hpv is high risk?: 16 and 18

99. by age 50 what percentage of US women will have acquired a genital HPV

infection?: 80%-HPV is very common, but it is the high risk ones to worry about 100. what is the most commonly sexually transmitted infection in the US?: - HPV

101. What percentage of bone loss do women have from the menopause transition?: 10 - 12% on average, about 1 t score 102. What t score defines osteopenia: - 1.5 to - 2.

103. what t score defines osteoporosis: less than - 2.

104. what z score defines osteoporosis before menopause?: z score less than 2.0 and a

history of a fragility fracture

105. Who is at highest risk of osteoporosis?: white and hispanic populations 106. 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

107. Asians have ____BMD than white people?: lower

108. Black women have ____BMD than white people?: higher

109. Over 3 servings of alcohol daily and risk for fracture?: 38% for osteoporotic fracture

and 68% for hip fracture

110. What 4 ethnic specific versions of FRAX are there?: white, asiain, black, hispanic

111. Dairy free diet amount of calicum. How much do they need to supplement?: dairy

free diet-300mg calcium daily. Needs 800-1200mg

112. 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

113. 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.

114. Black box warning for PTH receptor agonists?: osteosarcoma

115. caution using PTH receptor agonists in what condition?: hypercalcemia 116. when

would you use PTH receptor agonists?: someone incredibly high risk for vertebral fracture

117. raloxifene helps with what kind of fractures?: vertebral fractures

118. raloxifene risk factors: increased risk of death from stroke in high risk patients,

estrogen like risk of VTE, worsens hot flashes

119. atypical femur risk in women on bisphosphonate?: 1 in 1000 after 2-3 years.

120. Salmon calcitonin and osteoporosis?: small increase in spine BMD. daily SQ

injections or nasal.