NAMS MENOPAUSE CERTIFICATION EXAM 2026
ACTUAL REAL EXAM TEST BANK WITH 2
CURRENTLY TESTING VERSION
Question 1
A 52-year-old woman reports hot flashes, night sweats, and vaginal dryness.
Which symptom is most specifically linked to estrogen decline?
A) Night sweats
B) Vaginal dryness
C) Hot flashes
D) Mood swings
Correct Answer: B – Vaginal dryness is the most specific to estrogen decline
because it results directly from urogenital atrophy, whereas vasomotor symptoms
(hot flashes, night sweats) have multifactorial triggers and mood swings are less
directly linked.
Question 2
What is the first-line FDA-approved nonhormonal therapy for moderate-to-severe
vasomotor symptoms?
A) Gabapentin
B) Paroxetine salt
C) Clonidine
D) Black cohosh
Correct Answer: B – Paroxetine salt (Brisdelle) is the only FDA-approved
nonhormonal therapy specifically for vasomotor symptoms; gabapentin and
clonidine are off-label, and black cohosh lacks consistent evidence.
,Question 3
A 55-year-old with a uterus requests menopausal hormone therapy (MHT). To
avoid endometrial hyperplasia, which regimen is safest?
A) Estrogen alone
B) Estrogen + continuous progestogen
C) Estrogen + cyclic progestogen
D) Tibolone
Correct Answer: B – Continuous combined estrogen-progestogen eliminates
endometrial hyperplasia risk; cyclic regimens still cause withdrawal bleeding and
some risk, while estrogen alone is contraindicated with a uterus.
Question 4
Which laboratory finding confirms menopause in a 48-year-old with amenorrhea
for 10 months?
A) FSH 40 mIU/mL
B) Estradiol 50 pg/mL
C) FSH 10 mIU/mL
D) Inhibin B elevated
*Correct Answer: A – FSH >40 mIU/mL is diagnostic of menopause when
amenorrhea persists; low estradiol and low inhibin B support the diagnosis, but
FSH is the standard confirmatory test.*
Question 5
What is the increased absolute risk of breast cancer per year of MHT use in
women over 50?
A) Less than 1 per 1000
B) 5 per 1000
C) 10 per 1000
D) 20 per 1000
Correct Answer: A – The absolute increased risk is <1 per 1000 women per year of
use, based on WHI data; higher numbers overestimate risk and do not align with
current NAMS estimates.
,Question 6
For a woman with history of VTE, which MHT route is safest?
A) Oral conjugated equine estrogen
B) Oral estradiol
C) Transdermal estradiol
D) Oral estrogen with progestogen
Correct Answer: C – Transdermal estradiol avoids first-pass hepatic effect,
significantly reducing VTE risk; all oral routes increase VTE risk in susceptible
women.
Question 7
A 53-year-old reports severe vulvovaginal atrophy but refuses systemic MHT. What
is the preferred treatment?
A) Vaginal moisturizers
B) Vaginal estrogen (low-dose ring or tablet)
C) Oral ospemifene
D) Systemic estrogen
Correct Answer: B – Low-dose vaginal estrogen is the standard of care for
genitourinary syndrome of menopause (GSM) when systemic MHT is declined, as it
has minimal systemic absorption; moisturizers have mild effects, ospemifene is
second-line.
Question 8
Which bone mineral density T-score indicates osteoporosis by WHO criteria?
A) -1.0
B) -1.5
C) -2.5
D) -3.0
*Correct Answer: C – A T-score ≤ -2.5 defines osteoporosis; -1.0 to -2.4 is
osteopenia; -3.0 is severe osteoporosis but not the threshold.*
Question 9
What is the recommended starting daily dose of conjugated equine estrogen (CEE)
, for MHT?
A) 0.3 mg
B) 0.45 mg
C) 0.625 mg
D) 1.25 mg
Correct Answer: B – 0.45 mg is now the standard starting dose for CEE, lower than
the historical 0.625 mg, to minimize risks while controlling symptoms.
Question 10
A 50-year-old on MHT develops new-onset breast tenderness. What is the best
next step?
A) Stop MHT immediately
B) Reassure and consider adjusting dose or regimen
C) Order mammogram urgently
D) Switch to transdermal testosterone
Correct Answer: B – Breast tenderness is common in the first months; reassurance
and dose adjustment (lower estrogen or change progestogen) is first-line;
mammogram only if focal findings or persistent.
Question 11
Which symptom is NOT typically improved by MHT?
A) Vasomotor symptoms
B) Vulvovaginal atrophy
C) Sleep disturbance from night sweats
D) Urinary incontinence
Correct Answer: D – MHT does not improve stress or urge incontinence and may
worsen it in some studies; the other symptoms are proven benefits.
Question 12
At what age does the average woman reach menopause in the US?
A) 48
B) 51
ACTUAL REAL EXAM TEST BANK WITH 2
CURRENTLY TESTING VERSION
Question 1
A 52-year-old woman reports hot flashes, night sweats, and vaginal dryness.
Which symptom is most specifically linked to estrogen decline?
A) Night sweats
B) Vaginal dryness
C) Hot flashes
D) Mood swings
Correct Answer: B – Vaginal dryness is the most specific to estrogen decline
because it results directly from urogenital atrophy, whereas vasomotor symptoms
(hot flashes, night sweats) have multifactorial triggers and mood swings are less
directly linked.
Question 2
What is the first-line FDA-approved nonhormonal therapy for moderate-to-severe
vasomotor symptoms?
A) Gabapentin
B) Paroxetine salt
C) Clonidine
D) Black cohosh
Correct Answer: B – Paroxetine salt (Brisdelle) is the only FDA-approved
nonhormonal therapy specifically for vasomotor symptoms; gabapentin and
clonidine are off-label, and black cohosh lacks consistent evidence.
,Question 3
A 55-year-old with a uterus requests menopausal hormone therapy (MHT). To
avoid endometrial hyperplasia, which regimen is safest?
A) Estrogen alone
B) Estrogen + continuous progestogen
C) Estrogen + cyclic progestogen
D) Tibolone
Correct Answer: B – Continuous combined estrogen-progestogen eliminates
endometrial hyperplasia risk; cyclic regimens still cause withdrawal bleeding and
some risk, while estrogen alone is contraindicated with a uterus.
Question 4
Which laboratory finding confirms menopause in a 48-year-old with amenorrhea
for 10 months?
A) FSH 40 mIU/mL
B) Estradiol 50 pg/mL
C) FSH 10 mIU/mL
D) Inhibin B elevated
*Correct Answer: A – FSH >40 mIU/mL is diagnostic of menopause when
amenorrhea persists; low estradiol and low inhibin B support the diagnosis, but
FSH is the standard confirmatory test.*
Question 5
What is the increased absolute risk of breast cancer per year of MHT use in
women over 50?
A) Less than 1 per 1000
B) 5 per 1000
C) 10 per 1000
D) 20 per 1000
Correct Answer: A – The absolute increased risk is <1 per 1000 women per year of
use, based on WHI data; higher numbers overestimate risk and do not align with
current NAMS estimates.
,Question 6
For a woman with history of VTE, which MHT route is safest?
A) Oral conjugated equine estrogen
B) Oral estradiol
C) Transdermal estradiol
D) Oral estrogen with progestogen
Correct Answer: C – Transdermal estradiol avoids first-pass hepatic effect,
significantly reducing VTE risk; all oral routes increase VTE risk in susceptible
women.
Question 7
A 53-year-old reports severe vulvovaginal atrophy but refuses systemic MHT. What
is the preferred treatment?
A) Vaginal moisturizers
B) Vaginal estrogen (low-dose ring or tablet)
C) Oral ospemifene
D) Systemic estrogen
Correct Answer: B – Low-dose vaginal estrogen is the standard of care for
genitourinary syndrome of menopause (GSM) when systemic MHT is declined, as it
has minimal systemic absorption; moisturizers have mild effects, ospemifene is
second-line.
Question 8
Which bone mineral density T-score indicates osteoporosis by WHO criteria?
A) -1.0
B) -1.5
C) -2.5
D) -3.0
*Correct Answer: C – A T-score ≤ -2.5 defines osteoporosis; -1.0 to -2.4 is
osteopenia; -3.0 is severe osteoporosis but not the threshold.*
Question 9
What is the recommended starting daily dose of conjugated equine estrogen (CEE)
, for MHT?
A) 0.3 mg
B) 0.45 mg
C) 0.625 mg
D) 1.25 mg
Correct Answer: B – 0.45 mg is now the standard starting dose for CEE, lower than
the historical 0.625 mg, to minimize risks while controlling symptoms.
Question 10
A 50-year-old on MHT develops new-onset breast tenderness. What is the best
next step?
A) Stop MHT immediately
B) Reassure and consider adjusting dose or regimen
C) Order mammogram urgently
D) Switch to transdermal testosterone
Correct Answer: B – Breast tenderness is common in the first months; reassurance
and dose adjustment (lower estrogen or change progestogen) is first-line;
mammogram only if focal findings or persistent.
Question 11
Which symptom is NOT typically improved by MHT?
A) Vasomotor symptoms
B) Vulvovaginal atrophy
C) Sleep disturbance from night sweats
D) Urinary incontinence
Correct Answer: D – MHT does not improve stress or urge incontinence and may
worsen it in some studies; the other symptoms are proven benefits.
Question 12
At what age does the average woman reach menopause in the US?
A) 48
B) 51
