NAMS Menopause Certification Exam Questions and Answers with Rationales (Graded A+) |
2025/2026
1. Question: What is the climacteric phase?
A) The period of regular menstrual cycles
B) The period of endocrinologic, somatic, and psychologic changes around menopause
C) The cessation of ovulation
D) The final menstrual period
Answer: B
Rationale: The climacteric phase encompasses the transition from reproductive to non-
reproductive years, involving hormonal fluctuations and symptoms.
2. Question: What defines early menopause?
A) LMP before age 40
B) LMP before age 45
C) LMP after age 54
D) LMP after age 50
Answer: B
Rationale: Early menopause increases risks for cardiovascular disease and osteoporosis
due to prolonged estrogen deficiency.
3. Question: What defines late menopause?
A) LMP before age 45
B) LMP after age 50
C) LMP after age 54
D) LMP before age 40
Answer: C
Rationale: Delayed menopause may increase risks for estrogen-sensitive cancers due to
higher lifetime estrogen exposure.
4. Question: What is primary ovarian insufficiency (POI)?
A) Menopause after age 50
B) Menopause before age 40
C) Irregular cycles after age 45
D) Cessation of ovulation after age 55
Answer: B
Rationale: POI is diagnosed with oligomenorrhea/amenorrhea ≥4 months and FSH >25
IU/L twice, requiring prompt hormone therapy.
,5. Question: What characterizes the early menopause transition (stage -2)?
A) Amenorrhea for 60 days
B) Persistent cycle length difference of ≥7 days
C) Elevated progesterone levels
D) Stable FSH levels
Answer: B
Rationale: Results from follicular aging, leading to decreased inhibin B and variable FSH.
6. Question: What characterizes the late menopause transition (stage -1)?
A) Regular cycles
B) Amenorrhea ≥60 days
C) High progesterone levels
D) Low FSH levels
Answer: B
Rationale: Involves interval amenorrhea, with emerging GSM, bone loss, and CVD risks.
7. Question: What is a luteal out of phase event (LOOP)?
A) Elevated progesterone in follicular phase
B) Elevated FSH recruiting a second follicle in luteal phase
C) Decreased estradiol in perimenopause
D) Stable LH levels
Answer: B
Rationale: Explains elevated estrogen, contributing to heavy bleeding or PMS
exacerbation.
8. Question: How do estradiol levels differ in obese women during menopause?
A) Lower pre- and postmenopause
B) Higher premenopause, lower postmenopause
C) Anovulatory cycles with high estradiol; lower premenopause, higher postmenopause
D) No difference from normal-weight women
Answer: C
Rationale: Adiposity increases peripheral estrogen conversion, raising endometrial
cancer risk.
9. Question: Which ethnic groups have lower estradiol levels compared to white, black,
and Hispanic women?
A) Chinese and Japanese
B) Black and Hispanic
C) Indian and Korean
D) White and Chinese
, Answer: A
Rationale: Ethnic variations influence symptom severity and disease risks.
10. Question: What is stage +2 in menopause?
A) Early menopause transition
B) Late menopause: 5-8 years after FMP
C) Early postmenopause
D) Final menstrual period
Answer: B
Rationale: Urogenital atrophy becomes prominent, requiring targeted therapies.
11. Question: What are stages +1a, +1b, +1c?
A) Early menopause transition
B) Early postmenopause: 2 years after FMP
C) Late menopause transition
D) Late postmenopause
Answer: B
Rationale: VMS like hot flashes peak due to hormonal instability.
12. Question: What endocrine changes occur after menopause?
A) Decreased FSH and LH
B) Elevated FSH and LH
C) Stable FSH, elevated LH
D) Elevated progesterone
Answer: B
Rationale: Loss of ovarian feedback leads to hypergonadotropism.
13. Question: What roles do AMH and inhibin B play?
A) Increase follicle depletion
B) Prevent rapid follicle pool depletion
C) Stimulate ovulation
D) Increase FSH levels
Answer: B
Rationale: Levels decline with age, marking reduced ovarian reserve.
14. Question: How do menstrual cycles change during menopause transition, affecting PMS?
A) Lengthen, reducing PMS
B) Shorten, increasing luteal phase and PMS
C) Remain regular, no PMS change
D) Stop abruptly
, Answer: B
Rationale: Hormonal shifts prolong luteal exposure, exacerbating PMS.
15. Question: How should you respond if a patient requests an FSH lab?
A) Order immediately
B) Explain pitfalls: variable by cycle day, normal/low not helpful
C) Recommend AMH instead
D) Suggest progesterone testing
Answer: B
Rationale: FSH is unreliable for menopause timing; AMH or symptoms are better.
16. Question: What is the potentially superior marker of menopause?
A) FSH
B) LH
C) AMH
D) Progesterone
Answer: C
Rationale: Low AMH indicates low ovarian reserve; peaks at age 25.
17. Question: What are adrenal androgens?
A) Hormones increasing ovulation
B) Precursor hormones (e.g., DHEA) converted to androgens/estrogens
C) Hormones inhibiting estrogen production
D) Hormones regulating cortisol
Answer: B
Rationale: Secreted by zona reticularis; support postmenopause estrogen levels.
18. Question: Where are estrogen receptors located in the lower genital tract?
A) Cervix and ovaries
B) Vagina, vulva, urethra, bladder trigone
C) Uterus only
D) Bladder and kidneys
Answer: B
Rationale: Estrogen maintains blood flow, collagen, and microbiome acidity.
19. Question: What changes occur in the vagina and urethra during menopause?
A) Vagina widens, urethra moves away
B) Vagina narrows, urethra moves closer to introitus
C) No changes occur
D) Vagina lengthens, urethra shortens
2025/2026
1. Question: What is the climacteric phase?
A) The period of regular menstrual cycles
B) The period of endocrinologic, somatic, and psychologic changes around menopause
C) The cessation of ovulation
D) The final menstrual period
Answer: B
Rationale: The climacteric phase encompasses the transition from reproductive to non-
reproductive years, involving hormonal fluctuations and symptoms.
2. Question: What defines early menopause?
A) LMP before age 40
B) LMP before age 45
C) LMP after age 54
D) LMP after age 50
Answer: B
Rationale: Early menopause increases risks for cardiovascular disease and osteoporosis
due to prolonged estrogen deficiency.
3. Question: What defines late menopause?
A) LMP before age 45
B) LMP after age 50
C) LMP after age 54
D) LMP before age 40
Answer: C
Rationale: Delayed menopause may increase risks for estrogen-sensitive cancers due to
higher lifetime estrogen exposure.
4. Question: What is primary ovarian insufficiency (POI)?
A) Menopause after age 50
B) Menopause before age 40
C) Irregular cycles after age 45
D) Cessation of ovulation after age 55
Answer: B
Rationale: POI is diagnosed with oligomenorrhea/amenorrhea ≥4 months and FSH >25
IU/L twice, requiring prompt hormone therapy.
,5. Question: What characterizes the early menopause transition (stage -2)?
A) Amenorrhea for 60 days
B) Persistent cycle length difference of ≥7 days
C) Elevated progesterone levels
D) Stable FSH levels
Answer: B
Rationale: Results from follicular aging, leading to decreased inhibin B and variable FSH.
6. Question: What characterizes the late menopause transition (stage -1)?
A) Regular cycles
B) Amenorrhea ≥60 days
C) High progesterone levels
D) Low FSH levels
Answer: B
Rationale: Involves interval amenorrhea, with emerging GSM, bone loss, and CVD risks.
7. Question: What is a luteal out of phase event (LOOP)?
A) Elevated progesterone in follicular phase
B) Elevated FSH recruiting a second follicle in luteal phase
C) Decreased estradiol in perimenopause
D) Stable LH levels
Answer: B
Rationale: Explains elevated estrogen, contributing to heavy bleeding or PMS
exacerbation.
8. Question: How do estradiol levels differ in obese women during menopause?
A) Lower pre- and postmenopause
B) Higher premenopause, lower postmenopause
C) Anovulatory cycles with high estradiol; lower premenopause, higher postmenopause
D) No difference from normal-weight women
Answer: C
Rationale: Adiposity increases peripheral estrogen conversion, raising endometrial
cancer risk.
9. Question: Which ethnic groups have lower estradiol levels compared to white, black,
and Hispanic women?
A) Chinese and Japanese
B) Black and Hispanic
C) Indian and Korean
D) White and Chinese
, Answer: A
Rationale: Ethnic variations influence symptom severity and disease risks.
10. Question: What is stage +2 in menopause?
A) Early menopause transition
B) Late menopause: 5-8 years after FMP
C) Early postmenopause
D) Final menstrual period
Answer: B
Rationale: Urogenital atrophy becomes prominent, requiring targeted therapies.
11. Question: What are stages +1a, +1b, +1c?
A) Early menopause transition
B) Early postmenopause: 2 years after FMP
C) Late menopause transition
D) Late postmenopause
Answer: B
Rationale: VMS like hot flashes peak due to hormonal instability.
12. Question: What endocrine changes occur after menopause?
A) Decreased FSH and LH
B) Elevated FSH and LH
C) Stable FSH, elevated LH
D) Elevated progesterone
Answer: B
Rationale: Loss of ovarian feedback leads to hypergonadotropism.
13. Question: What roles do AMH and inhibin B play?
A) Increase follicle depletion
B) Prevent rapid follicle pool depletion
C) Stimulate ovulation
D) Increase FSH levels
Answer: B
Rationale: Levels decline with age, marking reduced ovarian reserve.
14. Question: How do menstrual cycles change during menopause transition, affecting PMS?
A) Lengthen, reducing PMS
B) Shorten, increasing luteal phase and PMS
C) Remain regular, no PMS change
D) Stop abruptly
, Answer: B
Rationale: Hormonal shifts prolong luteal exposure, exacerbating PMS.
15. Question: How should you respond if a patient requests an FSH lab?
A) Order immediately
B) Explain pitfalls: variable by cycle day, normal/low not helpful
C) Recommend AMH instead
D) Suggest progesterone testing
Answer: B
Rationale: FSH is unreliable for menopause timing; AMH or symptoms are better.
16. Question: What is the potentially superior marker of menopause?
A) FSH
B) LH
C) AMH
D) Progesterone
Answer: C
Rationale: Low AMH indicates low ovarian reserve; peaks at age 25.
17. Question: What are adrenal androgens?
A) Hormones increasing ovulation
B) Precursor hormones (e.g., DHEA) converted to androgens/estrogens
C) Hormones inhibiting estrogen production
D) Hormones regulating cortisol
Answer: B
Rationale: Secreted by zona reticularis; support postmenopause estrogen levels.
18. Question: Where are estrogen receptors located in the lower genital tract?
A) Cervix and ovaries
B) Vagina, vulva, urethra, bladder trigone
C) Uterus only
D) Bladder and kidneys
Answer: B
Rationale: Estrogen maintains blood flow, collagen, and microbiome acidity.
19. Question: What changes occur in the vagina and urethra during menopause?
A) Vagina widens, urethra moves away
B) Vagina narrows, urethra moves closer to introitus
C) No changes occur
D) Vagina lengthens, urethra shortens
