NAMS Menopause Certification Exam Study
with Answers
Question 1
Incidence of Hashimoto's is ____ fold more common in women
Correct Answer
7 (esp at midlife)
Question 2
choices for high intensity statin
Correct Answer
Atorva 40-80 mg
Rosuva 20-40 mg
Question 3
AEs of HT
Correct Answer
•Uterine bleeding (starting or returning)
•Breast tenderness (sometimes enlargement)
•Nausea
•Abdominal bloating
•Fluid retention in extremities
•Changes to the shape of the cornea (sometimes leading to contact lens
intolerance)
•Headache (sometimes migraine)
•Dizziness
•Mood changes with EPT, particularly with progestin
•Angioedema
•Gallstones, pancreatitis
Page 1 of 46
,Question 4
ethnicities at highest risk of DMT2
Correct Answer
American Indian, Black, Hispanic, Asian
Question 5
recommended starting drug therapy for HIGH risk pt?
ex: Patient aged 68 y, mother with hip fracture, T-score: FN -2.8, Wrist fracture at age
60
Correct Answer
Bisphosphonate or denosumab/Prolia (mAb)
Note: no limit on duration of denosumab therapy
Question 6
median duration of VMS
Correct Answer
7-10 yrs
Question 7
Tibolone and osteoporosis
MOA?
where is it approved?
why wasn't it submitted for approval in the US and canada?
Correct Answer
- MOA: weak estrogen agonist
- approved in mexico
- decreased risk of vertebral and nonvertebral fracture
- increased risk of stroke
Page 2 of 46
,Question 8
RFs for VMS
Correct Answer
•Low socioeconomic status
•Low educational attainment
•Obesity (only in perimenopause)
•Tobacco/Nicotine use
•Hysterectomy/Oophorectomy
Question 9
endometria thickness on postmenopausal U/S that rules out CA
Correct Answer
<4 mm (get US if >4 mm)
Question 10
black women have _______ BMD than white women
asian women have _______ BMD than white women
Correct Answer
higher
lower
Question 11
levels spike with ovulation, marker of ovarian reserve
Correct Answer
inhibin B
Question 12
association with VTE and HT?
Correct Answer
increased risk with oral ET
transdermal ET does not increase risk
MP less thrombotic than progestins
No risk with vaginal ET
Page 3 of 46
, Question 13
Luteal-Out-Of-Phase (LOOP) event
Correct Answer
- FSH elevation recruits follicles for the subsequent cycle before the current cycle is
over
- Excess estradiol production as new follicles start growing
- Increase chance of TWINS
- Very short follicular phase
- More time spent in luteal phase (more PMS/PMDD sx)
Question 14
highest estradiol option out of GSM treatments?
avg serum estradiol level with this?
Correct Answer
Estring, 8 pg/mL
others: 3-4 pg/mL (below normal postmeno ranges)
Question 15
when to do bisphosphonate holiday vs switch therapy?
when to restart therapy?
Correct Answer
- holiday: if they no longer meet criteria for therapy
- switch: for pt remaining at high fracture risk after 3 to 5 years of bisphosphonate
therapy, continue treatment or switch to another drug.
- restart: if bone loss or fx or when patient again meets criteria for treatment
Page 4 of 46
with Answers
Question 1
Incidence of Hashimoto's is ____ fold more common in women
Correct Answer
7 (esp at midlife)
Question 2
choices for high intensity statin
Correct Answer
Atorva 40-80 mg
Rosuva 20-40 mg
Question 3
AEs of HT
Correct Answer
•Uterine bleeding (starting or returning)
•Breast tenderness (sometimes enlargement)
•Nausea
•Abdominal bloating
•Fluid retention in extremities
•Changes to the shape of the cornea (sometimes leading to contact lens
intolerance)
•Headache (sometimes migraine)
•Dizziness
•Mood changes with EPT, particularly with progestin
•Angioedema
•Gallstones, pancreatitis
Page 1 of 46
,Question 4
ethnicities at highest risk of DMT2
Correct Answer
American Indian, Black, Hispanic, Asian
Question 5
recommended starting drug therapy for HIGH risk pt?
ex: Patient aged 68 y, mother with hip fracture, T-score: FN -2.8, Wrist fracture at age
60
Correct Answer
Bisphosphonate or denosumab/Prolia (mAb)
Note: no limit on duration of denosumab therapy
Question 6
median duration of VMS
Correct Answer
7-10 yrs
Question 7
Tibolone and osteoporosis
MOA?
where is it approved?
why wasn't it submitted for approval in the US and canada?
Correct Answer
- MOA: weak estrogen agonist
- approved in mexico
- decreased risk of vertebral and nonvertebral fracture
- increased risk of stroke
Page 2 of 46
,Question 8
RFs for VMS
Correct Answer
•Low socioeconomic status
•Low educational attainment
•Obesity (only in perimenopause)
•Tobacco/Nicotine use
•Hysterectomy/Oophorectomy
Question 9
endometria thickness on postmenopausal U/S that rules out CA
Correct Answer
<4 mm (get US if >4 mm)
Question 10
black women have _______ BMD than white women
asian women have _______ BMD than white women
Correct Answer
higher
lower
Question 11
levels spike with ovulation, marker of ovarian reserve
Correct Answer
inhibin B
Question 12
association with VTE and HT?
Correct Answer
increased risk with oral ET
transdermal ET does not increase risk
MP less thrombotic than progestins
No risk with vaginal ET
Page 3 of 46
, Question 13
Luteal-Out-Of-Phase (LOOP) event
Correct Answer
- FSH elevation recruits follicles for the subsequent cycle before the current cycle is
over
- Excess estradiol production as new follicles start growing
- Increase chance of TWINS
- Very short follicular phase
- More time spent in luteal phase (more PMS/PMDD sx)
Question 14
highest estradiol option out of GSM treatments?
avg serum estradiol level with this?
Correct Answer
Estring, 8 pg/mL
others: 3-4 pg/mL (below normal postmeno ranges)
Question 15
when to do bisphosphonate holiday vs switch therapy?
when to restart therapy?
Correct Answer
- holiday: if they no longer meet criteria for therapy
- switch: for pt remaining at high fracture risk after 3 to 5 years of bisphosphonate
therapy, continue treatment or switch to another drug.
- restart: if bone loss or fx or when patient again meets criteria for treatment
Page 4 of 46
