NAMS MENOPAUSE CERTIFICATION PRACTICE EXAMINATION
200 QUESTIONS COVERING ALL TESTED TOPICS COMPLETE
WITH 100% VERIFIED ANSWERS
Table of Contents
Section Domain Approx. Page
Questions Reference
I Reproductive Physiology and 25 Q1–Q25
Menopause Staging
II Vasomotor Symptoms and Sleep 25 Q26–Q50
Disturbances
III Genitourinary Syndrome of 20 Q51–Q70
Menopause and Sexual Health
IV Menopausal Hormone Therapy: 30 Q71–Q100
Regimens, Risks, and Benefits
V Non-Hormonal and Complementary 20 Q101–Q120
Therapies
VI Bone Health and Osteoporosis 20 Q121–Q140
VII Cardiovascular Health and Metabolic 15 Q141–Q155
Syndrome
VIII Mood Disorders and Cognitive Changes 15 Q156–Q170
IX Contraception and Preventive Care in 15 Q171–Q185
Midlife
X Special Populations and Patient 15 Q186–Q200
Counseling
,Section I: Reproductive Physiology and Menopause Staging (Questions
1–25)
1. According to the STRAW+10 staging system, which stage is
characterized by persistent ≥7-day difference in cycle length in two
consecutive cycles?
A. Stage -3b
B. Stage -3a
C. Stage -2
D. Stage -1
Rationale: The STRAW+10 staging system defines early menopause
transition (Stage -2) as persistent ≥7-day difference in cycle length in
two consecutive cycles. Stage -3b is late reproductive with subtle
changes, and Stage -1 is late menopause transition with ≥60-day
amenorrhea. (Source: Harlow et al., STRAW+10 staging system)
2. Which hormone is the primary estrogen produced by the ovary in a
premenopausal woman?
A. Estrone
B. Estriol
C. Estradiol
D. Estrone sulfate
Rationale: Estradiol (E2) is the predominant and most potent estrogen
produced by the ovaries in premenopausal women. Estrone (E1)
becomes the primary circulating estrogen after menopause, largely
from peripheral conversion of androgens. (Source: Endocrine Society
guidelines)
,3. What is the average age of natural menopause in the United States?
A. 45 years
B. 48 years
C. 51 years
D. 55 years
Rationale: The average age of natural menopause in the US is
approximately 51 years. Early menopause is defined as occurring before
age 45, and premature ovarian insufficiency before age 40. (Source:
NAMS position statements)
4. Which of the following is the most sensitive marker of ovarian
reserve and is used to predict the timing of menopause?
A. FSH
B. LH
C. AMH
D. Inhibin B
Rationale: Anti-Müllerian hormone (AMH) is produced by granulosa
cells of small antral follicles and is the most sensitive marker of ovarian
reserve. It declines progressively with age and predicts the timing of
menopause better than FSH. (Source: NAMS 2022 Hormone Therapy
Position Statement)
5. During the menopause transition, FSH levels increase primarily due
to which mechanism?
A. Increased hypothalamic GnRH secretion
B. Loss of negative feedback from inhibin and estradiol
C. Increased pituitary sensitivity to GnRH
D. Decreased clearance of FSH
, Rationale: The rise in FSH during the menopause transition is primarily
driven by the loss of negative feedback from ovarian inhibin and
estradiol on the pituitary. Inhibin B, produced by growing follicles,
selectively suppresses FSH. (Source: Endocrine Society clinical practice
guidelines)
6. Which of the following best describes the "climacteric phase"?
A. The period immediately following the final menstrual period
B. The period of endocrinologic, somatic, and psychologic changes
occurring around menopause
C. The first year after menopause
D. The period of perimenopause only
Rationale: The climacteric phase encompasses the entire period of
endocrinologic, somatic, and transitory psychologic changes that occur
around the time of menopause, including perimenopause and early
postmenopause. (Source: NAMS core curriculum)
7. A woman reports her last menstrual period was 14 months ago. She
is in which stage of the STRAW+10 system?
A. Stage -1
B. Stage +1a
C. Stage +1b
D. Stage +1c
Rationale: Stage +1a is the first 12 months after the final menstrual
period (early postmenopause). Stage +1b is 12–24 months post-FMP,
and Stage +1c is 24–60 months post-FMP. (Source: STRAW+10 staging
system)
8. Which of the following hormonal changes is NOT typically observed
during the menopause transition?
200 QUESTIONS COVERING ALL TESTED TOPICS COMPLETE
WITH 100% VERIFIED ANSWERS
Table of Contents
Section Domain Approx. Page
Questions Reference
I Reproductive Physiology and 25 Q1–Q25
Menopause Staging
II Vasomotor Symptoms and Sleep 25 Q26–Q50
Disturbances
III Genitourinary Syndrome of 20 Q51–Q70
Menopause and Sexual Health
IV Menopausal Hormone Therapy: 30 Q71–Q100
Regimens, Risks, and Benefits
V Non-Hormonal and Complementary 20 Q101–Q120
Therapies
VI Bone Health and Osteoporosis 20 Q121–Q140
VII Cardiovascular Health and Metabolic 15 Q141–Q155
Syndrome
VIII Mood Disorders and Cognitive Changes 15 Q156–Q170
IX Contraception and Preventive Care in 15 Q171–Q185
Midlife
X Special Populations and Patient 15 Q186–Q200
Counseling
,Section I: Reproductive Physiology and Menopause Staging (Questions
1–25)
1. According to the STRAW+10 staging system, which stage is
characterized by persistent ≥7-day difference in cycle length in two
consecutive cycles?
A. Stage -3b
B. Stage -3a
C. Stage -2
D. Stage -1
Rationale: The STRAW+10 staging system defines early menopause
transition (Stage -2) as persistent ≥7-day difference in cycle length in
two consecutive cycles. Stage -3b is late reproductive with subtle
changes, and Stage -1 is late menopause transition with ≥60-day
amenorrhea. (Source: Harlow et al., STRAW+10 staging system)
2. Which hormone is the primary estrogen produced by the ovary in a
premenopausal woman?
A. Estrone
B. Estriol
C. Estradiol
D. Estrone sulfate
Rationale: Estradiol (E2) is the predominant and most potent estrogen
produced by the ovaries in premenopausal women. Estrone (E1)
becomes the primary circulating estrogen after menopause, largely
from peripheral conversion of androgens. (Source: Endocrine Society
guidelines)
,3. What is the average age of natural menopause in the United States?
A. 45 years
B. 48 years
C. 51 years
D. 55 years
Rationale: The average age of natural menopause in the US is
approximately 51 years. Early menopause is defined as occurring before
age 45, and premature ovarian insufficiency before age 40. (Source:
NAMS position statements)
4. Which of the following is the most sensitive marker of ovarian
reserve and is used to predict the timing of menopause?
A. FSH
B. LH
C. AMH
D. Inhibin B
Rationale: Anti-Müllerian hormone (AMH) is produced by granulosa
cells of small antral follicles and is the most sensitive marker of ovarian
reserve. It declines progressively with age and predicts the timing of
menopause better than FSH. (Source: NAMS 2022 Hormone Therapy
Position Statement)
5. During the menopause transition, FSH levels increase primarily due
to which mechanism?
A. Increased hypothalamic GnRH secretion
B. Loss of negative feedback from inhibin and estradiol
C. Increased pituitary sensitivity to GnRH
D. Decreased clearance of FSH
, Rationale: The rise in FSH during the menopause transition is primarily
driven by the loss of negative feedback from ovarian inhibin and
estradiol on the pituitary. Inhibin B, produced by growing follicles,
selectively suppresses FSH. (Source: Endocrine Society clinical practice
guidelines)
6. Which of the following best describes the "climacteric phase"?
A. The period immediately following the final menstrual period
B. The period of endocrinologic, somatic, and psychologic changes
occurring around menopause
C. The first year after menopause
D. The period of perimenopause only
Rationale: The climacteric phase encompasses the entire period of
endocrinologic, somatic, and transitory psychologic changes that occur
around the time of menopause, including perimenopause and early
postmenopause. (Source: NAMS core curriculum)
7. A woman reports her last menstrual period was 14 months ago. She
is in which stage of the STRAW+10 system?
A. Stage -1
B. Stage +1a
C. Stage +1b
D. Stage +1c
Rationale: Stage +1a is the first 12 months after the final menstrual
period (early postmenopause). Stage +1b is 12–24 months post-FMP,
and Stage +1c is 24–60 months post-FMP. (Source: STRAW+10 staging
system)
8. Which of the following hormonal changes is NOT typically observed
during the menopause transition?
