, NAMS MENOPAUSE STUDY GUIDE FOR
WOMEN'S HEALTH NCMP CERTIFICATION
PREP
130 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Apply current evidence-based guidelines to diagnose and manage menopause and related disorders
2 Critically evaluate the risks and benefits of hormone therapy and non-hormonal alternatives in diverse
clinical scenarios
3 Integrate biopsychosocial and cultural factors into individualized menopause care plans
4 NAMS Menopause Study Guide for Women's Health NCMP Certification Prep
5 Foundations of Women's Health / Menopause Medicine
6 Applied Women's Health / Menopause Medicine
7 Advanced Women's Health / Menopause Medicine
8 Women's Health / Menopause Medicine Review
Q1 APPLY CURRENT EVIDENCE-BASED GUIDELINES TO DIAGNOSE AND MANAGE
MENOPAUSE AND RELATED DISORDERS
A 55-year-old postmenopausal woman with a history of venous thromboembolism
(VTE) and current vasomotor symptoms (VMS) requests treatment. Which of the
following is the most appropriate evidence-based recommendation?
A. Oral estradiol 1 mg daily with micronized progesterone 200 mg
B. Transdermal estradiol 0.05 mg/day with a levonorgestrel-releasing intrauterine system
C. Paroxetine 7.5 mg daily CORRECT
D. Gabapentin 300 mg at bedtime
RATIONALE: For women with a history of VTE, systemic estrogen is contraindicated; paroxetine
is FDA-approved for VMS and lacks VTE risk. Transdermal estrogen may have lower VTE risk
than oral but is still not recommended in this high-risk group. Gabapentin is off-label and less
effective than SSRIs for VMS.
Page 1
,Q2 APPLY CURRENT EVIDENCE-BASED GUIDELINES TO DIAGNOSE AND MANAGE
MENOPAUSE AND RELATED DISORDERS
Which of the following best explains the mechanism by which menopausal
hormone therapy (MHT) may increase breast cancer risk, according to the
Women's Health Initiative (WHI) and subsequent analyses?
A. Estrogen promotes proliferation of estrogen-receptor-positive breast cancer cells CORRECT
B. Progestin induces apoptosis in breast epithelial cells
C. MHT increases circulating insulin-like growth factor-1 (IGF-1) levels
D. MHT causes DNA mutations in BRCA1/BRCA2 genes
RATIONALE: The WHI showed that combined estrogen-progestin therapy increases breast
cancer risk, while estrogen alone (in hysterectomized women) showed no increase or even a
decrease. This is attributed to estrogen's mitogenic effect on estrogen-receptor-positive cells,
with progestins potentiating this effect. IGF-1 and BRCA mutations are not primary mechanisms.
Q3 APPLY CURRENT EVIDENCE-BASED GUIDELINES TO DIAGNOSE AND MANAGE
MENOPAUSE AND RELATED DISORDERS
In a postmenopausal woman with bothersome vulvovaginal atrophy (VVA) who
has had breast cancer and is taking an aromatase inhibitor, which of the following
treatments is most appropriate as first-line therapy?
A. Low-dose vaginal estrogen cream
B. Ospemifene 60 mg daily
C. Vaginal moisturizers and lubricants CORRECT
D. Systemic hormone therapy with estradiol and progesterone
RATIONALE: For breast cancer survivors on aromatase inhibitors, systemic estrogen is
contraindicated, and vaginal estrogen is generally avoided due to potential absorption and risk.
Ospemifene is also contraindicated in breast cancer. Non-hormonal vaginal moisturizers and
lubricants are the recommended first-line options.
Page 2
, Q4 APPLY CURRENT EVIDENCE-BASED GUIDELINES TO DIAGNOSE AND MANAGE
MENOPAUSE AND RELATED DISORDERS
A 48-year-old woman with a body mass index (BMI) of 32 kg/m² and a family
history of osteoporosis presents with irregular menses and hot flashes. Her FSH is
25 mIU/mL. Which of the following is the most appropriate next step in
management?
A. Initiate low-dose oral contraceptive pill for symptom control
B. Order a bone density scan (DXA) and assess fracture risk CORRECT
C. Start menopausal hormone therapy with transdermal estradiol
D. Recommend lifestyle modifications and reassess in 6 months
RATIONALE: The patient is likely perimenopausal (elevated FSH, irregular menses) and has
osteoporosis risk factors (low BMI, family history). DXA is indicated to assess bone health. OCPs
can be used for contraception and symptom control but do not address bone density
assessment. MHT is not yet indicated without confirmed menopause and may be premature.
Q5 APPLY CURRENT EVIDENCE-BASED GUIDELINES TO DIAGNOSE AND MANAGE
MENOPAUSE AND RELATED DISORDERS
Which of the following statements accurately describes the effect of menopausal
hormone therapy (MHT) on cardiovascular risk when initiated in women within 10
years of menopause?
A. MHT consistently increases the risk of myocardial infarction regardless of timing
B. MHT reduces cardiovascular risk in all age groups
C. MHT may reduce coronary heart disease risk if initiated early, but increases risk if initiated
later CORRECT
D. MHT has no effect on cardiovascular disease risk
RATIONALE: The timing hypothesis suggests that MHT initiated in early menopause may have a
cardioprotective effect, while initiation later is associated with increased cardiovascular risk. This
is supported by subgroup analyses of the WHI and observational studies. MHT is not
recommended solely for cardiovascular protection.
Page 3
WOMEN'S HEALTH NCMP CERTIFICATION
PREP
130 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Apply current evidence-based guidelines to diagnose and manage menopause and related disorders
2 Critically evaluate the risks and benefits of hormone therapy and non-hormonal alternatives in diverse
clinical scenarios
3 Integrate biopsychosocial and cultural factors into individualized menopause care plans
4 NAMS Menopause Study Guide for Women's Health NCMP Certification Prep
5 Foundations of Women's Health / Menopause Medicine
6 Applied Women's Health / Menopause Medicine
7 Advanced Women's Health / Menopause Medicine
8 Women's Health / Menopause Medicine Review
Q1 APPLY CURRENT EVIDENCE-BASED GUIDELINES TO DIAGNOSE AND MANAGE
MENOPAUSE AND RELATED DISORDERS
A 55-year-old postmenopausal woman with a history of venous thromboembolism
(VTE) and current vasomotor symptoms (VMS) requests treatment. Which of the
following is the most appropriate evidence-based recommendation?
A. Oral estradiol 1 mg daily with micronized progesterone 200 mg
B. Transdermal estradiol 0.05 mg/day with a levonorgestrel-releasing intrauterine system
C. Paroxetine 7.5 mg daily CORRECT
D. Gabapentin 300 mg at bedtime
RATIONALE: For women with a history of VTE, systemic estrogen is contraindicated; paroxetine
is FDA-approved for VMS and lacks VTE risk. Transdermal estrogen may have lower VTE risk
than oral but is still not recommended in this high-risk group. Gabapentin is off-label and less
effective than SSRIs for VMS.
Page 1
,Q2 APPLY CURRENT EVIDENCE-BASED GUIDELINES TO DIAGNOSE AND MANAGE
MENOPAUSE AND RELATED DISORDERS
Which of the following best explains the mechanism by which menopausal
hormone therapy (MHT) may increase breast cancer risk, according to the
Women's Health Initiative (WHI) and subsequent analyses?
A. Estrogen promotes proliferation of estrogen-receptor-positive breast cancer cells CORRECT
B. Progestin induces apoptosis in breast epithelial cells
C. MHT increases circulating insulin-like growth factor-1 (IGF-1) levels
D. MHT causes DNA mutations in BRCA1/BRCA2 genes
RATIONALE: The WHI showed that combined estrogen-progestin therapy increases breast
cancer risk, while estrogen alone (in hysterectomized women) showed no increase or even a
decrease. This is attributed to estrogen's mitogenic effect on estrogen-receptor-positive cells,
with progestins potentiating this effect. IGF-1 and BRCA mutations are not primary mechanisms.
Q3 APPLY CURRENT EVIDENCE-BASED GUIDELINES TO DIAGNOSE AND MANAGE
MENOPAUSE AND RELATED DISORDERS
In a postmenopausal woman with bothersome vulvovaginal atrophy (VVA) who
has had breast cancer and is taking an aromatase inhibitor, which of the following
treatments is most appropriate as first-line therapy?
A. Low-dose vaginal estrogen cream
B. Ospemifene 60 mg daily
C. Vaginal moisturizers and lubricants CORRECT
D. Systemic hormone therapy with estradiol and progesterone
RATIONALE: For breast cancer survivors on aromatase inhibitors, systemic estrogen is
contraindicated, and vaginal estrogen is generally avoided due to potential absorption and risk.
Ospemifene is also contraindicated in breast cancer. Non-hormonal vaginal moisturizers and
lubricants are the recommended first-line options.
Page 2
, Q4 APPLY CURRENT EVIDENCE-BASED GUIDELINES TO DIAGNOSE AND MANAGE
MENOPAUSE AND RELATED DISORDERS
A 48-year-old woman with a body mass index (BMI) of 32 kg/m² and a family
history of osteoporosis presents with irregular menses and hot flashes. Her FSH is
25 mIU/mL. Which of the following is the most appropriate next step in
management?
A. Initiate low-dose oral contraceptive pill for symptom control
B. Order a bone density scan (DXA) and assess fracture risk CORRECT
C. Start menopausal hormone therapy with transdermal estradiol
D. Recommend lifestyle modifications and reassess in 6 months
RATIONALE: The patient is likely perimenopausal (elevated FSH, irregular menses) and has
osteoporosis risk factors (low BMI, family history). DXA is indicated to assess bone health. OCPs
can be used for contraception and symptom control but do not address bone density
assessment. MHT is not yet indicated without confirmed menopause and may be premature.
Q5 APPLY CURRENT EVIDENCE-BASED GUIDELINES TO DIAGNOSE AND MANAGE
MENOPAUSE AND RELATED DISORDERS
Which of the following statements accurately describes the effect of menopausal
hormone therapy (MHT) on cardiovascular risk when initiated in women within 10
years of menopause?
A. MHT consistently increases the risk of myocardial infarction regardless of timing
B. MHT reduces cardiovascular risk in all age groups
C. MHT may reduce coronary heart disease risk if initiated early, but increases risk if initiated
later CORRECT
D. MHT has no effect on cardiovascular disease risk
RATIONALE: The timing hypothesis suggests that MHT initiated in early menopause may have a
cardioprotective effect, while initiation later is associated with increased cardiovascular risk. This
is supported by subgroup analyses of the WHI and observational studies. MHT is not
recommended solely for cardiovascular protection.
Page 3
