2025 NAMS Menopause Certification
Intensive Review: Hormones, HRT, and
Clinical Cases
When should preventative migraine medication be considered?
A. One mild headache per month
B. Migraines occurring ≥2 times per week or severely affecting quality of life
C. Only after trying triptans
D. After one emergency room visit
Rationale: Prophylactic therapy is recommended when migraines are frequent or significantly
impair function. Less frequent or mild headaches do not require daily medication.
Triptans are contraindicated in patients with
A. Hypothyroidism
B. Asthma
C. Cardiovascular disease
D. Iron deficiency
Rationale: Triptans cause vasoconstriction and are unsafe in cardiovascular disease. NSAIDs
share similar vascular risk. Asthma or hypothyroidism are not absolute contraindications.
Treatment for menstrual migraines includes
A. Daily steroids two weeks before menses
B. Avoiding all NSAIDs
C. NSAID or triptan starting 2 days before menstruation and continued for 5–7 days
D. Antibiotics
Rationale: Short-term perimenstrual prophylaxis with NSAIDs or triptans is effective. Steroids
and antibiotics are not appropriate.
According to CDC and WHO guidelines, women with migraine with aura should
A. Freely use combined hormonal contraception
B. Avoid combined hormonal contraception due to risk of stroke
C. Use high-dose estrogen patches
,D. Take aspirin daily
Rationale: Estrogen-containing contraceptives increase stroke risk in women with aura.
Migraine without aura requires caution but is not an absolute contraindication.
Arthralgia from vitamin D deficiency or hypothyroidism may take how long to fully resolve with
treatment?
A. 1–2 weeks
B. 1 month
C. Several months
D. Never
Rationale: Musculoskeletal symptoms may take months to improve after vitamin D or thyroid
levels normalize.
The most common form of arthritis is
A. Rheumatoid arthritis
B. Gout
C. Osteoarthritis
D. Psoriatic arthritis
Rationale: Osteoarthritis is the most prevalent arthritis, especially in postmenopausal women.
Brain regions with the highest density of estrogen receptors include
A. Occipital cortex and brainstem
B. Hippocampus and prefrontal cortex
C. Cerebellum only
D. Basal ganglia
Rationale: Estrogen receptors are concentrated in areas associated with memory and cognition,
such as the hippocampus and prefrontal cortex.
Most common thyroid disorder in women is
A. Graves disease
B. Subacute thyroiditis
C. Hashimoto thyroiditis
D. Toxic nodular goiter
Rationale: Hashimoto’s is the most common cause of hypothyroidism in women.
,A woman on levothyroxine starts oral estrogen. What is the correct management?
A. Stop levothyroxine
B. Recheck TSH in 6–8 weeks and anticipate need for higher levothyroxine dose
C. Lower levothyroxine dose immediately
D. No follow-up required
Rationale: Oral estrogen increases thyroid-binding globulin, lowering free T4. Levothyroxine
dose often must be increased after rechecking in 6–8 weeks.
Treatment for subclinical hypothyroidism is recommended when TSH is
A. <2 mIU/L
B. 5–7 mIU/L
C. >10 mIU/L
D. Only if T4 is high
Rationale: Guidelines recommend treatment when TSH >10 due to higher cardiovascular and
metabolic risk.
Cold thyroid nodules are typically
A. Always benign
B. More likely to be malignant than hot nodules
C. Caused by iodine overdose
D. Always cystic
Rationale: Cold nodules (non-functioning) carry higher malignancy risk compared to
hyperfunctioning (hot) nodules.
How does oral hormone replacement therapy affect gallbladder disease risk?
A. Decreases gallstone formation
B. No effect on gallbladder
C. Increases gallstone risk; lower risk with transdermal estrogen
D. Only affects the kidneys
Rationale: Oral estrogen increases biliary cholesterol saturation, raising gallstone risk;
transdermal routes avoid first-pass hepatic metabolism.
, Screening of blood for hepatitis C began in
A. 1980
B. 1985
C. 1992
D. 2005
Rationale: Routine screening of blood products for HCV started in 1992.
Why do we screen for hepatitis C?
A. It always causes acute liver failure
B. Most infections become chronic and asymptomatic until liver damage occurs
C. Treatment is ineffective
D. Only transmitted sexually
Rationale: Chronic silent infection leads to cirrhosis and cancer; early detection improves
outcomes with curative antivirals.
Adults born between which years should receive one-time hepatitis C testing?
A. 1920–1940
B. 1945–1965
C. 1970–1990
D. Only those under 30
Rationale: Baby boomers have the highest prevalence of HCV and should be screened once.
Which HPV types are considered high risk for cervical cancer?
A. HPV 6 and 11
B. HPV 16 and 18
C. HPV 1 and 3
D. HPV 33 only
Rationale: HPV types 16 and 18 are responsible for approximately 70% of cervical cancers.
Types 6 and 11 cause genital warts and are low risk.
By age 50, approximately what percentage of U.S. women will have acquired a genital HPV
infection?
A. 20%
B. 40%
C. 80%
D. 100%
Intensive Review: Hormones, HRT, and
Clinical Cases
When should preventative migraine medication be considered?
A. One mild headache per month
B. Migraines occurring ≥2 times per week or severely affecting quality of life
C. Only after trying triptans
D. After one emergency room visit
Rationale: Prophylactic therapy is recommended when migraines are frequent or significantly
impair function. Less frequent or mild headaches do not require daily medication.
Triptans are contraindicated in patients with
A. Hypothyroidism
B. Asthma
C. Cardiovascular disease
D. Iron deficiency
Rationale: Triptans cause vasoconstriction and are unsafe in cardiovascular disease. NSAIDs
share similar vascular risk. Asthma or hypothyroidism are not absolute contraindications.
Treatment for menstrual migraines includes
A. Daily steroids two weeks before menses
B. Avoiding all NSAIDs
C. NSAID or triptan starting 2 days before menstruation and continued for 5–7 days
D. Antibiotics
Rationale: Short-term perimenstrual prophylaxis with NSAIDs or triptans is effective. Steroids
and antibiotics are not appropriate.
According to CDC and WHO guidelines, women with migraine with aura should
A. Freely use combined hormonal contraception
B. Avoid combined hormonal contraception due to risk of stroke
C. Use high-dose estrogen patches
,D. Take aspirin daily
Rationale: Estrogen-containing contraceptives increase stroke risk in women with aura.
Migraine without aura requires caution but is not an absolute contraindication.
Arthralgia from vitamin D deficiency or hypothyroidism may take how long to fully resolve with
treatment?
A. 1–2 weeks
B. 1 month
C. Several months
D. Never
Rationale: Musculoskeletal symptoms may take months to improve after vitamin D or thyroid
levels normalize.
The most common form of arthritis is
A. Rheumatoid arthritis
B. Gout
C. Osteoarthritis
D. Psoriatic arthritis
Rationale: Osteoarthritis is the most prevalent arthritis, especially in postmenopausal women.
Brain regions with the highest density of estrogen receptors include
A. Occipital cortex and brainstem
B. Hippocampus and prefrontal cortex
C. Cerebellum only
D. Basal ganglia
Rationale: Estrogen receptors are concentrated in areas associated with memory and cognition,
such as the hippocampus and prefrontal cortex.
Most common thyroid disorder in women is
A. Graves disease
B. Subacute thyroiditis
C. Hashimoto thyroiditis
D. Toxic nodular goiter
Rationale: Hashimoto’s is the most common cause of hypothyroidism in women.
,A woman on levothyroxine starts oral estrogen. What is the correct management?
A. Stop levothyroxine
B. Recheck TSH in 6–8 weeks and anticipate need for higher levothyroxine dose
C. Lower levothyroxine dose immediately
D. No follow-up required
Rationale: Oral estrogen increases thyroid-binding globulin, lowering free T4. Levothyroxine
dose often must be increased after rechecking in 6–8 weeks.
Treatment for subclinical hypothyroidism is recommended when TSH is
A. <2 mIU/L
B. 5–7 mIU/L
C. >10 mIU/L
D. Only if T4 is high
Rationale: Guidelines recommend treatment when TSH >10 due to higher cardiovascular and
metabolic risk.
Cold thyroid nodules are typically
A. Always benign
B. More likely to be malignant than hot nodules
C. Caused by iodine overdose
D. Always cystic
Rationale: Cold nodules (non-functioning) carry higher malignancy risk compared to
hyperfunctioning (hot) nodules.
How does oral hormone replacement therapy affect gallbladder disease risk?
A. Decreases gallstone formation
B. No effect on gallbladder
C. Increases gallstone risk; lower risk with transdermal estrogen
D. Only affects the kidneys
Rationale: Oral estrogen increases biliary cholesterol saturation, raising gallstone risk;
transdermal routes avoid first-pass hepatic metabolism.
, Screening of blood for hepatitis C began in
A. 1980
B. 1985
C. 1992
D. 2005
Rationale: Routine screening of blood products for HCV started in 1992.
Why do we screen for hepatitis C?
A. It always causes acute liver failure
B. Most infections become chronic and asymptomatic until liver damage occurs
C. Treatment is ineffective
D. Only transmitted sexually
Rationale: Chronic silent infection leads to cirrhosis and cancer; early detection improves
outcomes with curative antivirals.
Adults born between which years should receive one-time hepatitis C testing?
A. 1920–1940
B. 1945–1965
C. 1970–1990
D. Only those under 30
Rationale: Baby boomers have the highest prevalence of HCV and should be screened once.
Which HPV types are considered high risk for cervical cancer?
A. HPV 6 and 11
B. HPV 16 and 18
C. HPV 1 and 3
D. HPV 33 only
Rationale: HPV types 16 and 18 are responsible for approximately 70% of cervical cancers.
Types 6 and 11 cause genital warts and are low risk.
By age 50, approximately what percentage of U.S. women will have acquired a genital HPV
infection?
A. 20%
B. 40%
C. 80%
D. 100%
