NAMS Menopause Certification
ACTUAL EXAM 2026/2027: 100%
Verified Questions & Correct Answers
Question 1:
A 52-year-old G3P3 presents with 6 months of skipped menses, moderate-hot flashes 6×/ day
awakening her twice nightly, and new vaginal dryness interfering with intercourse. BMI 26, BP
118/74, no personal or family history of breast cancer, no thromboembolic events. FSH 32
IU/L, estradiol 28 pg/mL. She desires effective systemic therapy. Per 2023 NAMS Position
Statement, which initial prescription is most appropriate?
A. Conjugated equine estrogen 0.625 mg daily
B. Transdermal 17-β-estradiol 50 µg + micronized progesterone 100 mg
C. Oral estradiol 2 mg + medroxyprogesterone acetate 5 mg
D. Low-dose combined oral contraceptive for 12 months
Correct Answer: B
Rationale: Transdermal estradiol avoids first-pass hepatic effect and is preferred for women
aged 50-59 or <10 yrs post-menopause; micronized progesterone has the most favorable
breast-safety and cardiovascular profile per 2022 NAMS Hormone Therapy Position
Statement.
Question 2:
A 48-year-old perimenopausal woman with BMI 32 and migraine with aura wishes relief of
vasomotor symptoms. She is intolerant of SSRIs. Which evidence-based non-hormonal
option should be recommended first?
A. High-dose vitamin E 800 IU daily
B. Extended-release gabapentin 600 mg hs
C. Black cohosh 40 mg nightly
,D. Paroxetine 7.5 mg hs
Correct Answer: B
Rationale: Extended-release gabapentin is FDA-approved for vasomotor symptoms and is
safe in migraine with aura; vitamin E and black cohosh lack consistent benefit, while
paroxetine is contraindicated in migraine with aura per 2023 NAMS Non-Hormonal Rx
Algorithm.
Question 3:
A 55-year-old woman, 7 years post-menopause, reports persistent vaginal burning and
dyspareunia despite 6 months of OTC moisturizers. On exam, vulvar skin is pale and shiny,
vaginal pH 6.5, wet mount shows parabasal cells. Which initial prescription aligns with 2021
NAMS Genitourinary Syndrome of Menopause terminology?
A. Oral ospemifene 60 mg daily
B. Intravaginal prasterone 6.5 mg nightly × 2 weeks then twice weekly
C. Intravaginal estrogen 0.3 mg CEE twice weekly
D. Vaginal laser therapy single session
Correct Answer: B
Rationale: Prasterone (DHEA) is FDA-approved for moderate-severe GSM; converts locally to
estrogen and testosterone, maintaining serum hormone levels in post-menopausal range per
NAMS 2022 GSM Position Statement.
Question 4:
A 60-year-old woman (T-score spine −2.6) discontinued bisphosphonate after 5 years due to
GI intolerance. FRAX major fracture 23 %. Which next agent best reduces fracture risk
according to 2022 NAMS/NOF Guidelines?
A. Restart alendronate weekly
B. Romosozumab 210 mg SC monthly × 12 months
C. Raloxifene 60 mg daily
D. Calcitonin nasal spray 200 IU daily
,Correct Answer: B
Rationale: Romosozumab is anabolic followed by antiresorptive sequence recommended for
high-risk women intolerant of bisphosphonates; reduces vertebral fracture 73 % vs placebo
per FRAME study cited in 2023 NAMS Osteoporosis Position Statement.
Question 5:
A 49-year-old woman reports mood lability, irritability, and poor sleep since menses became
irregular 8 months ago. PHQ-9 12, GAD-7 8, no suicidal ideation. She prefers non-systemic
therapy. Which intervention has the strongest evidence per 2023 NAMS Cognitive & Mood
Position Statement?
A. Cognitive-behavioral therapy for insomnia 6 weekly sessions
B. Escitalopram 10 mg daily
C. Transdermal progesterone 300 mg nightly
D. Isoflavones 50 mg twice daily
Correct Answer: A
Rationale: CBT-I improves both sleep and mood in perimenopausal women with moderate
effect size (Cohen d 0.6) and is first-line for mild-moderate mood symptoms without
hormonal or pharmacologic risk.
Question 6:
A 53-year-old woman on continuous combined transdermal HT (E2 50 µg/NETA 140 µg patch
weekly) for 4 years requests discontinuation because her hot flashes are gone. She is willing
to taper. Which tapering plan best minimizes recurrence per 2023 NAMS HT Discontinuation
Review?
A. Stop patch immediately; resume if flashes recur
B. Switch to E2 25 µg/NETA 70 µg patch every 7 days for 3 months, then every 10 days for 3
months, then stop
C. Apply patch every 10 days now; stop after 2 months
D. Switch to low-dose oral CEE 0.3 mg + BZA for 1 year
Correct Answer: B
, Rationale: Gradual dose and interval reduction ↓ rebound VMS by 55 % vs abrupt cessation
per NAMS 2023 tapering consensus.
Question 7:
A 51-year-old breast-cancer survivor (ER+/PR+, stage I, 3 yrs post-tamoxifen) has severe hot
flashes (>10/day). Oncologist clears non-hormonal options. Which agent is most effective
and safe?
A. Venlafaxine extended-release 37.5 mg daily
B. Micronized progesterone 100 mg hs
C. Testosterone 2 mg + estradiol 0.5 mg SL
D. Conjugated equine estrogen 0.3 mg
Correct Answer: A
Rationale: SNRIs are first-line in breast-cancer survivors; hormonal agents contraindicated per
2022 NAMS Breast Cancer Survivors Position Statement.
Question 8:
A 54-year-old woman reports waking 4×/night with hot flashes since chemotherapy-induced
menopause 2 yrs ago. She drinks 2 coffees and 2 wines daily. Which initial counseling best
aligns with 2023 NAMS Lifestyle Guidelines?
A. Avoid caffeine and alcohol after 2 pm; keep bedroom ≤ 68 °F; layered bedding
B. Start daily soy protein 25 g
C. Begin 0.3 mg oral estrogen nightly
D. Add 800 mg ibuprofen hs
Correct Answer: A
Rationale: Randomized trials show 30 % reduction in nighttime VMS frequency with
caffeine/alcohol restriction and cool environment per 2023 NAMS Lifestyle Evidence Review.
Question 9:
ACTUAL EXAM 2026/2027: 100%
Verified Questions & Correct Answers
Question 1:
A 52-year-old G3P3 presents with 6 months of skipped menses, moderate-hot flashes 6×/ day
awakening her twice nightly, and new vaginal dryness interfering with intercourse. BMI 26, BP
118/74, no personal or family history of breast cancer, no thromboembolic events. FSH 32
IU/L, estradiol 28 pg/mL. She desires effective systemic therapy. Per 2023 NAMS Position
Statement, which initial prescription is most appropriate?
A. Conjugated equine estrogen 0.625 mg daily
B. Transdermal 17-β-estradiol 50 µg + micronized progesterone 100 mg
C. Oral estradiol 2 mg + medroxyprogesterone acetate 5 mg
D. Low-dose combined oral contraceptive for 12 months
Correct Answer: B
Rationale: Transdermal estradiol avoids first-pass hepatic effect and is preferred for women
aged 50-59 or <10 yrs post-menopause; micronized progesterone has the most favorable
breast-safety and cardiovascular profile per 2022 NAMS Hormone Therapy Position
Statement.
Question 2:
A 48-year-old perimenopausal woman with BMI 32 and migraine with aura wishes relief of
vasomotor symptoms. She is intolerant of SSRIs. Which evidence-based non-hormonal
option should be recommended first?
A. High-dose vitamin E 800 IU daily
B. Extended-release gabapentin 600 mg hs
C. Black cohosh 40 mg nightly
,D. Paroxetine 7.5 mg hs
Correct Answer: B
Rationale: Extended-release gabapentin is FDA-approved for vasomotor symptoms and is
safe in migraine with aura; vitamin E and black cohosh lack consistent benefit, while
paroxetine is contraindicated in migraine with aura per 2023 NAMS Non-Hormonal Rx
Algorithm.
Question 3:
A 55-year-old woman, 7 years post-menopause, reports persistent vaginal burning and
dyspareunia despite 6 months of OTC moisturizers. On exam, vulvar skin is pale and shiny,
vaginal pH 6.5, wet mount shows parabasal cells. Which initial prescription aligns with 2021
NAMS Genitourinary Syndrome of Menopause terminology?
A. Oral ospemifene 60 mg daily
B. Intravaginal prasterone 6.5 mg nightly × 2 weeks then twice weekly
C. Intravaginal estrogen 0.3 mg CEE twice weekly
D. Vaginal laser therapy single session
Correct Answer: B
Rationale: Prasterone (DHEA) is FDA-approved for moderate-severe GSM; converts locally to
estrogen and testosterone, maintaining serum hormone levels in post-menopausal range per
NAMS 2022 GSM Position Statement.
Question 4:
A 60-year-old woman (T-score spine −2.6) discontinued bisphosphonate after 5 years due to
GI intolerance. FRAX major fracture 23 %. Which next agent best reduces fracture risk
according to 2022 NAMS/NOF Guidelines?
A. Restart alendronate weekly
B. Romosozumab 210 mg SC monthly × 12 months
C. Raloxifene 60 mg daily
D. Calcitonin nasal spray 200 IU daily
,Correct Answer: B
Rationale: Romosozumab is anabolic followed by antiresorptive sequence recommended for
high-risk women intolerant of bisphosphonates; reduces vertebral fracture 73 % vs placebo
per FRAME study cited in 2023 NAMS Osteoporosis Position Statement.
Question 5:
A 49-year-old woman reports mood lability, irritability, and poor sleep since menses became
irregular 8 months ago. PHQ-9 12, GAD-7 8, no suicidal ideation. She prefers non-systemic
therapy. Which intervention has the strongest evidence per 2023 NAMS Cognitive & Mood
Position Statement?
A. Cognitive-behavioral therapy for insomnia 6 weekly sessions
B. Escitalopram 10 mg daily
C. Transdermal progesterone 300 mg nightly
D. Isoflavones 50 mg twice daily
Correct Answer: A
Rationale: CBT-I improves both sleep and mood in perimenopausal women with moderate
effect size (Cohen d 0.6) and is first-line for mild-moderate mood symptoms without
hormonal or pharmacologic risk.
Question 6:
A 53-year-old woman on continuous combined transdermal HT (E2 50 µg/NETA 140 µg patch
weekly) for 4 years requests discontinuation because her hot flashes are gone. She is willing
to taper. Which tapering plan best minimizes recurrence per 2023 NAMS HT Discontinuation
Review?
A. Stop patch immediately; resume if flashes recur
B. Switch to E2 25 µg/NETA 70 µg patch every 7 days for 3 months, then every 10 days for 3
months, then stop
C. Apply patch every 10 days now; stop after 2 months
D. Switch to low-dose oral CEE 0.3 mg + BZA for 1 year
Correct Answer: B
, Rationale: Gradual dose and interval reduction ↓ rebound VMS by 55 % vs abrupt cessation
per NAMS 2023 tapering consensus.
Question 7:
A 51-year-old breast-cancer survivor (ER+/PR+, stage I, 3 yrs post-tamoxifen) has severe hot
flashes (>10/day). Oncologist clears non-hormonal options. Which agent is most effective
and safe?
A. Venlafaxine extended-release 37.5 mg daily
B. Micronized progesterone 100 mg hs
C. Testosterone 2 mg + estradiol 0.5 mg SL
D. Conjugated equine estrogen 0.3 mg
Correct Answer: A
Rationale: SNRIs are first-line in breast-cancer survivors; hormonal agents contraindicated per
2022 NAMS Breast Cancer Survivors Position Statement.
Question 8:
A 54-year-old woman reports waking 4×/night with hot flashes since chemotherapy-induced
menopause 2 yrs ago. She drinks 2 coffees and 2 wines daily. Which initial counseling best
aligns with 2023 NAMS Lifestyle Guidelines?
A. Avoid caffeine and alcohol after 2 pm; keep bedroom ≤ 68 °F; layered bedding
B. Start daily soy protein 25 g
C. Begin 0.3 mg oral estrogen nightly
D. Add 800 mg ibuprofen hs
Correct Answer: A
Rationale: Randomized trials show 30 % reduction in nighttime VMS frequency with
caffeine/alcohol restriction and cool environment per 2023 NAMS Lifestyle Evidence Review.
Question 9:
