2026/2027 MSCP EXAM STUDY GUIDE
- MENOPAUSE SOCIETY CERTFIED
PRACTITIONER WITH 86 QUESTIONS
AND CORRECT ANSWERS RATED A+
Menopause (definition)
Permanent cessation of menstruation due to loss of ovarian follicular activity, diagnosed
after 12 consecutive months of amenorrhea. Mean age: 51.4 years.
Menopause Transition
The period beginning with variable menstrual cycle length and ending with the final
menstrual period (FMP). Characterized by hormonal fluctuations and emerging
symptoms.
Postmenopause
The time after the final menstrual period. Early postmenopause = first ~6 years;
vasomotor symptoms most prominent. Late postmenopause = increased bone loss and
CVD risk.
DOMAIN 1: Physiology/Pathophysiology of the Menopause Transition (19%)
This domain covers 19% of the exam. Topics: definitions/demographics (5%), STRAW
stages (4%), physiology (5%), POI and surgical menopause (5%).
STRAW+10 Staging System
Stages of Reproductive Aging Workshop: Late Reproductive → Early Transition
(variable cycle length) → Late Transition (≥2 skipped cycles, ≥60-day gaps) → Early
Postmenopause (~6 yrs) → Late Postmenopause.
Dominant Symptoms by STRAW Stage
Early transition: irregular cycles, premenstrual symptoms. Late transition: skipped
cycles, VMS begin. Early postmenopause: peak VMS, sleep disruption, GSM begins.
Late postmenopause: GSM, bone loss, CVD risk.
LOOP Events (Luteal Out-of-Phase)
Anovulatory cycles where estrogen rises but progesterone is absent. Causes irregular
bleeding and risk of endometrial hyperplasia. Common in perimenopause.
Fertility Changes in Perimenopause
Declining ovarian reserve → rising FSH, falling inhibin B, then declining estradiol. Anti-
Müllerian hormone (AMH) declines earliest. Pregnancy is still possible until confirmed
menopause.
Premature Ovarian Insufficiency (POI)
Amenorrhea + FSH >25 mIU/mL before age 40. Causes: genetic (Turner syndrome,
fragile X premutation), autoimmune, iatrogenic (chemo/radiation). Requires hormone
therapy for health protection.
Surgical Menopause
, Bilateral oophorectomy causes immediate estrogen loss + ~50% androgen loss. More
abrupt and severe symptoms than natural menopause. HT strongly recommended
unless contraindicated. GSM Differential Diagnosis
Vaginitis (BV, yeast, trichomonas), contact dermatitis, lichen sclerosus, lichen planus,
vulvar cancer, vulvar masses. Requires pelvic exam for accurate diagnosis.
Abnormal Uterine Bleeding (AUB)
Any bleeding outside normal menstrual parameters. PALM-COEIN classification: Polyp,
Adenomyosis, Leiomyoma, Malignancy/hyperplasia (structural); Coagulopathy,
Ovulatory disorders, Endometrial, Iatrogenic, Not classified (non-structural).
AUB Evaluation
History and physical exam, pregnancy test, CBC, TSH, coagulation studies, pelvic
ultrasound, endometrial biopsy (if >45 or risk factors for hyperplasia), hysteroscopy.
Sexual Health Changes in Menopause
Decreased libido (HSDD), decreased arousal, lubrication difficulties, dyspareunia,
anorgasmia. Caused by estrogen/androgen decline, GSM, psychosocial factors,
relationship issues.
Sexual Health Treatments
Local vaginal estrogen, vaginal DHEA (prasterone), ospemifene (oral SERM), systemic
HT, testosterone (off-label), pelvic floor PT, lubricants, psychotherapy/sex therapy,
vibrators.
Sleep Changes in Menopause
Insomnia, sleep fragmentation, early awakening. Caused by night sweats, circadian
changes, mood disorders. Differential: restless leg syndrome (iron deficiency),
obstructive sleep apnea (increases post-menopause), primary insomnia.
Sleep Treatment
CBT-I (first-line), sleep hygiene, melatonin, HT for night sweats, gabapentin,
eszopiclone, zolpidem. Treat underlying sleep apnea (CPAP).
Cognitive and Mood Changes
Perimenopausal "window of vulnerability" for depression and anxiety. Subjective
cognitive complaints common. MRI changes in brain energy metabolism. HT may have
neuroprotective effects when initiated early.
Weight Changes in Menopause
Average gain ~1.5 lb/year. Central adiposity increases due to hormonal shifts even
without weight gain. Increases CVD and metabolic risk. Management: caloric restriction,
aerobic + resistance exercise, pharmacotherapy (GLP-1 agonists), bariatric surgery.
Arthralgia in Menopause
Joint pain common in peri/postmenopause. Estrogen has anti-inflammatory effects.
Differential: osteoarthritis, rheumatoid arthritis, fibromyalgia, drug-induced (AIs can
cause severe joint pain). Management: NSAIDs, exercise, HT may help.
Pelvic Floor Disorders
Urinary incontinence types: stress (cough/sneeze), urge (overactive bladder), mixed.
High-tone pelvic floor dysfunction causes dyspareunia, constipation. Management:
pelvic floor PT, bladder training, anticholinergics, beta-3 agonists, surgery.
DOMAIN 3: Health Disorders in Midlife (21%)
- MENOPAUSE SOCIETY CERTFIED
PRACTITIONER WITH 86 QUESTIONS
AND CORRECT ANSWERS RATED A+
Menopause (definition)
Permanent cessation of menstruation due to loss of ovarian follicular activity, diagnosed
after 12 consecutive months of amenorrhea. Mean age: 51.4 years.
Menopause Transition
The period beginning with variable menstrual cycle length and ending with the final
menstrual period (FMP). Characterized by hormonal fluctuations and emerging
symptoms.
Postmenopause
The time after the final menstrual period. Early postmenopause = first ~6 years;
vasomotor symptoms most prominent. Late postmenopause = increased bone loss and
CVD risk.
DOMAIN 1: Physiology/Pathophysiology of the Menopause Transition (19%)
This domain covers 19% of the exam. Topics: definitions/demographics (5%), STRAW
stages (4%), physiology (5%), POI and surgical menopause (5%).
STRAW+10 Staging System
Stages of Reproductive Aging Workshop: Late Reproductive → Early Transition
(variable cycle length) → Late Transition (≥2 skipped cycles, ≥60-day gaps) → Early
Postmenopause (~6 yrs) → Late Postmenopause.
Dominant Symptoms by STRAW Stage
Early transition: irregular cycles, premenstrual symptoms. Late transition: skipped
cycles, VMS begin. Early postmenopause: peak VMS, sleep disruption, GSM begins.
Late postmenopause: GSM, bone loss, CVD risk.
LOOP Events (Luteal Out-of-Phase)
Anovulatory cycles where estrogen rises but progesterone is absent. Causes irregular
bleeding and risk of endometrial hyperplasia. Common in perimenopause.
Fertility Changes in Perimenopause
Declining ovarian reserve → rising FSH, falling inhibin B, then declining estradiol. Anti-
Müllerian hormone (AMH) declines earliest. Pregnancy is still possible until confirmed
menopause.
Premature Ovarian Insufficiency (POI)
Amenorrhea + FSH >25 mIU/mL before age 40. Causes: genetic (Turner syndrome,
fragile X premutation), autoimmune, iatrogenic (chemo/radiation). Requires hormone
therapy for health protection.
Surgical Menopause
, Bilateral oophorectomy causes immediate estrogen loss + ~50% androgen loss. More
abrupt and severe symptoms than natural menopause. HT strongly recommended
unless contraindicated. GSM Differential Diagnosis
Vaginitis (BV, yeast, trichomonas), contact dermatitis, lichen sclerosus, lichen planus,
vulvar cancer, vulvar masses. Requires pelvic exam for accurate diagnosis.
Abnormal Uterine Bleeding (AUB)
Any bleeding outside normal menstrual parameters. PALM-COEIN classification: Polyp,
Adenomyosis, Leiomyoma, Malignancy/hyperplasia (structural); Coagulopathy,
Ovulatory disorders, Endometrial, Iatrogenic, Not classified (non-structural).
AUB Evaluation
History and physical exam, pregnancy test, CBC, TSH, coagulation studies, pelvic
ultrasound, endometrial biopsy (if >45 or risk factors for hyperplasia), hysteroscopy.
Sexual Health Changes in Menopause
Decreased libido (HSDD), decreased arousal, lubrication difficulties, dyspareunia,
anorgasmia. Caused by estrogen/androgen decline, GSM, psychosocial factors,
relationship issues.
Sexual Health Treatments
Local vaginal estrogen, vaginal DHEA (prasterone), ospemifene (oral SERM), systemic
HT, testosterone (off-label), pelvic floor PT, lubricants, psychotherapy/sex therapy,
vibrators.
Sleep Changes in Menopause
Insomnia, sleep fragmentation, early awakening. Caused by night sweats, circadian
changes, mood disorders. Differential: restless leg syndrome (iron deficiency),
obstructive sleep apnea (increases post-menopause), primary insomnia.
Sleep Treatment
CBT-I (first-line), sleep hygiene, melatonin, HT for night sweats, gabapentin,
eszopiclone, zolpidem. Treat underlying sleep apnea (CPAP).
Cognitive and Mood Changes
Perimenopausal "window of vulnerability" for depression and anxiety. Subjective
cognitive complaints common. MRI changes in brain energy metabolism. HT may have
neuroprotective effects when initiated early.
Weight Changes in Menopause
Average gain ~1.5 lb/year. Central adiposity increases due to hormonal shifts even
without weight gain. Increases CVD and metabolic risk. Management: caloric restriction,
aerobic + resistance exercise, pharmacotherapy (GLP-1 agonists), bariatric surgery.
Arthralgia in Menopause
Joint pain common in peri/postmenopause. Estrogen has anti-inflammatory effects.
Differential: osteoarthritis, rheumatoid arthritis, fibromyalgia, drug-induced (AIs can
cause severe joint pain). Management: NSAIDs, exercise, HT may help.
Pelvic Floor Disorders
Urinary incontinence types: stress (cough/sneeze), urge (overactive bladder), mixed.
High-tone pelvic floor dysfunction causes dyspareunia, constipation. Management:
pelvic floor PT, bladder training, anticholinergics, beta-3 agonists, surgery.
DOMAIN 3: Health Disorders in Midlife (21%)
