2025 NAMS Menopause Certification
Comprehensive Review and Q&A
Workbook
Which type of hair loss is characterized by sudden onset and often triggered by stress, illness, or
medications?
a) Female pattern hair loss
b) Telogen effluvium
c) Alopecia areata
d) Androgenic alopecia
Rationale: Telogen effluvium is sudden and typically triggered by stress or illness. FPHL is
gradual (incorrect). Alopecia areata is autoimmune with patchy hair loss (incorrect). Androgenic
alopecia is another term for FPHL (incorrect).
Which pattern is characteristic of female pattern hair loss (FPHL)?
a) Receding hairline only
b) Thinning at the crown and widening of the hair part
c) Patchy bald spots on the scalp
d) Total scalp hair loss
Rationale: FPHL presents as thinning at the crown and widening of the part. Receding hairline is
more typical of male pattern baldness. Patchy loss is seen in alopecia areata. Total loss is seen in
alopecia totalis.
What is the first-line treatment for female pattern hair loss?
a) Ketoconazole shampoo
b) Minoxidil
c) Cortisone injections
d) Oral antibiotics
Rationale: Minoxidil is the primary treatment. Spironolactone and finasteride may be adjuncts
but are not first-line. Others are not standard treatments.
,Which ethnicity is least likely to experience severe hot flashes?
a) Black
b) Hispanic
c) Japanese
d) White
Rationale: Japanese women have the lowest rates of severe vasomotor symptoms. Black
women have the highest (incorrect). Others are intermediate.
Median duration of hot flashes during menopause transition is approximately:
a) 2 years
b) 5 years
c) 10 years
d) 15 years
Rationale: The median duration is about 10 years. 2 and 5 years underestimate it. 15 years is
less common.
Which type of vulvar intraepithelial neoplasia (VIN) requires wide local excision due to high
cancer risk?
a) Low-grade VIN
b) High-grade VIN
c) Differentiated VIN
d) HPV-negative VIN
Rationale: Differentiated VIN has high risk of invasive carcinoma and needs excision. Low-grade
is not precancerous. High-grade is precancerous but referred to GYN oncology.
What is the most common type of vulvar cancer?
a) Adenocarcinoma
b) Melanoma
c) Sarcoma
d) Squamous cell carcinoma
Rationale: Squamous cell carcinoma is the most prevalent. Others are far less common.
Which vulvar disorder is commonly misdiagnosed as eczema and does NOT improve with
steroids?
,a) Lichen sclerosus
b) Paget’s disease
c) Contact dermatitis
d) Psoriasis
Rationale: Paget’s disease mimics eczema but does not respond to steroids. Others typically
respond to steroid therapy.
Normal post-void residual bladder volume (PVR) is:
a) 0–50 mL
b) 100–200 mL
c) <100 mL
d) >200 mL
Rationale: Normal PVR is less than 100 mL. Over 200 mL is abnormal.
Systemic and vaginal estrogen do NOT improve which type of urinary incontinence?
a) Urge incontinence
b) Mixed incontinence
c) Overflow incontinence
d) Stress incontinence
Rationale: Estrogen therapy does not significantly improve stress incontinence. It may help urge
incontinence (incorrect).
Which topical vaginal estrogen delivers the highest dose?
a) Vaginal cream
b) Tablet inserts
c) Vaginal ring (Femring)
d) Oral estrogen
Rationale: Femring provides the highest systemic dose among vaginal estrogens. Creams and
tablets deliver lower doses.
Most common cause of vulvovaginitis in women?
a) Candida infection
b) Trichomonas
c) Bacterial vaginosis (BV)
, d) Atrophic vaginitis
Rationale: BV is the most common. Candida is second most common. Others are less prevalent.
Postmenopausal burning, yellow/brown discharge, and dyspareunia that does not improve with
local estrogen therapy is most likely:
a) Atrophic vaginitis
b) Bacterial vaginosis
c) Desquamative inflammatory vaginitis
d) Trichomoniasis
Rationale: Desquamative inflammatory vaginitis presents with burning, yellow/brown
discharge, dyspareunia, and does not respond to estrogen. BV and trichomonas usually have
odor or frothy discharge. Atrophic vaginitis typically improves with estrogen.
Which hormone is most associated with sexual desire in women?
a) Progesterone
b) Estrogen
c) Circulating androgens
d) Prolactin
Rationale: Circulating androgens (testosterone, DHEA) are key for libido. Estrogen affects
lubrication, not desire. Progesterone and prolactin do not stimulate sexual interest.
Women who undergo bilateral salpingo-oophorectomy (BSO) experience an abrupt decline in:
a) Estrogen alone
b) Progesterone alone
c) Circulating androgen levels
d) Oxytocin
Rationale: BSO removes ovaries, leading to sharp decline in circulating androgens and estrogen,
but decline in androgens is especially abrupt and persistent.
Hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD) were
combined into which diagnosis?
a) Female orgasmic disorder
b) Female sexual interest/arousal disorder
c) Genito-pelvic pain disorder
d) Sexual aversion disorder
Comprehensive Review and Q&A
Workbook
Which type of hair loss is characterized by sudden onset and often triggered by stress, illness, or
medications?
a) Female pattern hair loss
b) Telogen effluvium
c) Alopecia areata
d) Androgenic alopecia
Rationale: Telogen effluvium is sudden and typically triggered by stress or illness. FPHL is
gradual (incorrect). Alopecia areata is autoimmune with patchy hair loss (incorrect). Androgenic
alopecia is another term for FPHL (incorrect).
Which pattern is characteristic of female pattern hair loss (FPHL)?
a) Receding hairline only
b) Thinning at the crown and widening of the hair part
c) Patchy bald spots on the scalp
d) Total scalp hair loss
Rationale: FPHL presents as thinning at the crown and widening of the part. Receding hairline is
more typical of male pattern baldness. Patchy loss is seen in alopecia areata. Total loss is seen in
alopecia totalis.
What is the first-line treatment for female pattern hair loss?
a) Ketoconazole shampoo
b) Minoxidil
c) Cortisone injections
d) Oral antibiotics
Rationale: Minoxidil is the primary treatment. Spironolactone and finasteride may be adjuncts
but are not first-line. Others are not standard treatments.
,Which ethnicity is least likely to experience severe hot flashes?
a) Black
b) Hispanic
c) Japanese
d) White
Rationale: Japanese women have the lowest rates of severe vasomotor symptoms. Black
women have the highest (incorrect). Others are intermediate.
Median duration of hot flashes during menopause transition is approximately:
a) 2 years
b) 5 years
c) 10 years
d) 15 years
Rationale: The median duration is about 10 years. 2 and 5 years underestimate it. 15 years is
less common.
Which type of vulvar intraepithelial neoplasia (VIN) requires wide local excision due to high
cancer risk?
a) Low-grade VIN
b) High-grade VIN
c) Differentiated VIN
d) HPV-negative VIN
Rationale: Differentiated VIN has high risk of invasive carcinoma and needs excision. Low-grade
is not precancerous. High-grade is precancerous but referred to GYN oncology.
What is the most common type of vulvar cancer?
a) Adenocarcinoma
b) Melanoma
c) Sarcoma
d) Squamous cell carcinoma
Rationale: Squamous cell carcinoma is the most prevalent. Others are far less common.
Which vulvar disorder is commonly misdiagnosed as eczema and does NOT improve with
steroids?
,a) Lichen sclerosus
b) Paget’s disease
c) Contact dermatitis
d) Psoriasis
Rationale: Paget’s disease mimics eczema but does not respond to steroids. Others typically
respond to steroid therapy.
Normal post-void residual bladder volume (PVR) is:
a) 0–50 mL
b) 100–200 mL
c) <100 mL
d) >200 mL
Rationale: Normal PVR is less than 100 mL. Over 200 mL is abnormal.
Systemic and vaginal estrogen do NOT improve which type of urinary incontinence?
a) Urge incontinence
b) Mixed incontinence
c) Overflow incontinence
d) Stress incontinence
Rationale: Estrogen therapy does not significantly improve stress incontinence. It may help urge
incontinence (incorrect).
Which topical vaginal estrogen delivers the highest dose?
a) Vaginal cream
b) Tablet inserts
c) Vaginal ring (Femring)
d) Oral estrogen
Rationale: Femring provides the highest systemic dose among vaginal estrogens. Creams and
tablets deliver lower doses.
Most common cause of vulvovaginitis in women?
a) Candida infection
b) Trichomonas
c) Bacterial vaginosis (BV)
, d) Atrophic vaginitis
Rationale: BV is the most common. Candida is second most common. Others are less prevalent.
Postmenopausal burning, yellow/brown discharge, and dyspareunia that does not improve with
local estrogen therapy is most likely:
a) Atrophic vaginitis
b) Bacterial vaginosis
c) Desquamative inflammatory vaginitis
d) Trichomoniasis
Rationale: Desquamative inflammatory vaginitis presents with burning, yellow/brown
discharge, dyspareunia, and does not respond to estrogen. BV and trichomonas usually have
odor or frothy discharge. Atrophic vaginitis typically improves with estrogen.
Which hormone is most associated with sexual desire in women?
a) Progesterone
b) Estrogen
c) Circulating androgens
d) Prolactin
Rationale: Circulating androgens (testosterone, DHEA) are key for libido. Estrogen affects
lubrication, not desire. Progesterone and prolactin do not stimulate sexual interest.
Women who undergo bilateral salpingo-oophorectomy (BSO) experience an abrupt decline in:
a) Estrogen alone
b) Progesterone alone
c) Circulating androgen levels
d) Oxytocin
Rationale: BSO removes ovaries, leading to sharp decline in circulating androgens and estrogen,
but decline in androgens is especially abrupt and persistent.
Hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD) were
combined into which diagnosis?
a) Female orgasmic disorder
b) Female sexual interest/arousal disorder
c) Genito-pelvic pain disorder
d) Sexual aversion disorder
