NAMS CERTIFIED MENOPAUSE
PRACTITIONER PRACTICE EXAM
QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A 52-year-old woman presents with irregular menses, hot flashes, and sleep
disturbance for 6 months. Which hormonal change most directly contributes
to vasomotor symptoms?
A. Decline in progesterone
B. Fluctuating estrogen levels
C. Increase in follicle-stimulating hormone
D. Decline in testosterone
Correct Answer: B
Rationale: Vasomotor symptoms are primarily related to fluctuating and declining
estrogen levels, which disrupt hypothalamic thermoregulation.
, 2. Which finding best defines the menopausal transition (perimenopause)?
A. Absence of menses for 12 months
B. Elevated estradiol levels
C. Variability in menstrual cycle length
D. Complete ovarian failure
Correct Answer: C
Rationale: Perimenopause is characterized by hormonal fluctuation and irregular
cycles; menopause is defined retrospectively after 12 months of amenorrhea.
3. A healthy 54-year-old woman is considering menopausal hormone therapy
(MHT) for moderate hot flashes. She has an intact uterus. Which regimen is
most appropriate?
A. Estrogen alone
B. Progesterone alone
C. Combined estrogen-progestogen therapy
D. Selective estrogen receptor modulator
Correct Answer: C
Rationale: Women with an intact uterus require progestogen with estrogen to
reduce the risk of endometrial hyperplasia and cancer.
4. Which route of estrogen therapy is associated with a lower risk of venous
thromboembolism?
A. Oral conjugated estrogen
B. Oral estradiol
C. Transdermal estradiol
D. Intravaginal estrogen
Correct Answer: C
Rationale: Transdermal estrogen bypasses first-pass hepatic metabolism and is
associated with a lower VTE risk compared to oral formulations.
, 5. A 56-year-old woman with bothersome genitourinary syndrome of
menopause (GSM) but no vasomotor symptoms is best treated with:
A. Systemic estrogen therapy
B. Vaginal estrogen therapy
C. SSRIs
D. Bisphosphonates
Correct Answer: B
Rationale: Local vaginal estrogen effectively treats GSM with minimal systemic
absorption.
6. Which symptom is most strongly associated with estrogen deficiency rather
than aging alone?
A. Decreased libido
B. Vaginal dryness
C. Weight gain
D. Memory lapses
Correct Answer: B
Rationale: Vaginal dryness and atrophy are directly related to estrogen deficiency.
7. A 58-year-old woman with a history of estrogen receptor–positive breast
cancer asks about menopausal symptom management. Which option is most
appropriate for vasomotor symptoms?
A. Systemic estrogen therapy
B. Low-dose vaginal estrogen
C. Paroxetine
D. Tibolone
Correct Answer: C
Rationale: Nonhormonal therapies such as SSRIs are preferred for vasomotor
symptoms in women with a history of hormone-sensitive breast cancer.
, 8. Which factor increases the risk of earlier natural menopause?
A. Obesity
B. Multiparity
C. Cigarette smoking
D. Late menarche
Correct Answer: C
Rationale: Smoking accelerates follicular depletion and is associated with earlier
menopause.
9. The primary mechanism of hot flashes involves dysfunction of the:
A. Pituitary-ovarian axis
B. Hypothalamic thermoregulatory center
C. Adrenal cortex
D. Peripheral vasculature
Correct Answer: B
Rationale: Estrogen withdrawal narrows the thermoneutral zone in the
hypothalamus, triggering vasomotor symptoms.
10. Which laboratory test confirms menopause in a woman over age 45 with
typical symptoms?
A. Estradiol level
B. FSH level
C. Anti-Müllerian hormone
D. No testing required
Correct Answer: D
Rationale: In women over 45, menopause is a clinical diagnosis and laboratory
testing is generally unnecessary.
PRACTITIONER PRACTICE EXAM
QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A 52-year-old woman presents with irregular menses, hot flashes, and sleep
disturbance for 6 months. Which hormonal change most directly contributes
to vasomotor symptoms?
A. Decline in progesterone
B. Fluctuating estrogen levels
C. Increase in follicle-stimulating hormone
D. Decline in testosterone
Correct Answer: B
Rationale: Vasomotor symptoms are primarily related to fluctuating and declining
estrogen levels, which disrupt hypothalamic thermoregulation.
, 2. Which finding best defines the menopausal transition (perimenopause)?
A. Absence of menses for 12 months
B. Elevated estradiol levels
C. Variability in menstrual cycle length
D. Complete ovarian failure
Correct Answer: C
Rationale: Perimenopause is characterized by hormonal fluctuation and irregular
cycles; menopause is defined retrospectively after 12 months of amenorrhea.
3. A healthy 54-year-old woman is considering menopausal hormone therapy
(MHT) for moderate hot flashes. She has an intact uterus. Which regimen is
most appropriate?
A. Estrogen alone
B. Progesterone alone
C. Combined estrogen-progestogen therapy
D. Selective estrogen receptor modulator
Correct Answer: C
Rationale: Women with an intact uterus require progestogen with estrogen to
reduce the risk of endometrial hyperplasia and cancer.
4. Which route of estrogen therapy is associated with a lower risk of venous
thromboembolism?
A. Oral conjugated estrogen
B. Oral estradiol
C. Transdermal estradiol
D. Intravaginal estrogen
Correct Answer: C
Rationale: Transdermal estrogen bypasses first-pass hepatic metabolism and is
associated with a lower VTE risk compared to oral formulations.
, 5. A 56-year-old woman with bothersome genitourinary syndrome of
menopause (GSM) but no vasomotor symptoms is best treated with:
A. Systemic estrogen therapy
B. Vaginal estrogen therapy
C. SSRIs
D. Bisphosphonates
Correct Answer: B
Rationale: Local vaginal estrogen effectively treats GSM with minimal systemic
absorption.
6. Which symptom is most strongly associated with estrogen deficiency rather
than aging alone?
A. Decreased libido
B. Vaginal dryness
C. Weight gain
D. Memory lapses
Correct Answer: B
Rationale: Vaginal dryness and atrophy are directly related to estrogen deficiency.
7. A 58-year-old woman with a history of estrogen receptor–positive breast
cancer asks about menopausal symptom management. Which option is most
appropriate for vasomotor symptoms?
A. Systemic estrogen therapy
B. Low-dose vaginal estrogen
C. Paroxetine
D. Tibolone
Correct Answer: C
Rationale: Nonhormonal therapies such as SSRIs are preferred for vasomotor
symptoms in women with a history of hormone-sensitive breast cancer.
, 8. Which factor increases the risk of earlier natural menopause?
A. Obesity
B. Multiparity
C. Cigarette smoking
D. Late menarche
Correct Answer: C
Rationale: Smoking accelerates follicular depletion and is associated with earlier
menopause.
9. The primary mechanism of hot flashes involves dysfunction of the:
A. Pituitary-ovarian axis
B. Hypothalamic thermoregulatory center
C. Adrenal cortex
D. Peripheral vasculature
Correct Answer: B
Rationale: Estrogen withdrawal narrows the thermoneutral zone in the
hypothalamus, triggering vasomotor symptoms.
10. Which laboratory test confirms menopause in a woman over age 45 with
typical symptoms?
A. Estradiol level
B. FSH level
C. Anti-Müllerian hormone
D. No testing required
Correct Answer: D
Rationale: In women over 45, menopause is a clinical diagnosis and laboratory
testing is generally unnecessary.
