MSCP Exam Study Guide - Menopause Society Certified Practitioner
Postmenopause The time after the final menstrual period. Early postmenopause = first ~6 years;
vasomotor symptoms most prominent. Late postmenopause = increased bone
loss and CVD risk.
STRAW+10 Staging System Stages of Reproductive Aging Workshop: Late Reproductive → Early Transition
(variable cycle length) → Late Transition (≥2 skipped cycles, ≥60-day gaps) →
Early Postmenopause (~6 yrs) → Late Postmenopause.
Dominant Symptoms by STRAW Stage Early transition: irregular cycles, premenstrual symptoms. Late transition:
skipped cycles, VMS begin. Early postmenopause: peak VMS, sleep disruption,
GSM begins. Late postmenopause: GSM, bone loss, CVD risk.
LOOP Events (Luteal Out-of-Phase) Anovulatory cycles where estrogen rises but progesterone is absent. Causes
irregular bleeding and risk of endometrial hyperplasia. Common in
perimenopause.
Fertility Changes in Perimenopause Declining ovarian reserve → rising FSH, falling inhibin B, then declining
estradiol. Anti-Müllerian hormone (AMH) declines earliest. Pregnancy is still
possible until confirmed menopause.
Premature Ovarian Insufficiency (POI) Amenorrhea + FSH >25 mIU/mL before age 40. Causes: genetic (Turner
syndrome, fragile X premutation), autoimmune, iatrogenic (chemo/radiation).
Requires hormone therapy for health protection.
Surgical Menopause Bilateral oophorectomy causes immediate estrogen loss + ~50% androgen loss.
More abrupt and severe symptoms than natural menopause. HT strongly
recommended unless contraindicated.
Clinical Consequences of Early Estrogen Loss Accelerated bone loss, increased CVD risk, cognitive effects, severe VMS,
premature GSM. In POI/surgical menopause, HT should be initiated promptly
and continued at least until average age of natural menopause (51).
DOMAIN 2: Symptoms and Concerns (20%) This domain covers 20% of the exam. Topics: weight (2%), hair (1%), sleep (2%),
sexual health (2%), breast symptoms (2%), AUB (2%), arthralgia (1%), VMS (2%),
GSM (2%), pelvic floor (2%), cognition/mood (2%).
Vasomotor Symptoms (VMS) Hot flashes and night sweats caused by narrowing of the thermoregulatory set
point. Affect ~70-80% of women. Peak in late transition and early
postmenopause. Can last >7 years on average (longer in some populations).
VMS Risk Factors Higher BMI, African American ethnicity, smoking, anxiety, depression, lower
educational level, surgical menopause. Timing and duration vary by
race/ethnicity (Study of Women's Health Across the Nation - SWAN).
, MSCP Exam Study Guide - Menopause Society Certified Practitioner
Genitourinary Syndrome of Menopause (GSM) Umbrella term for vulvovaginal and lower urinary tract symptoms due to
estrogen deficiency. Includes vaginal dryness, dyspareunia, burning, urgency,
recurrent UTIs. Unlike VMS, GSM is chronic and progressive without treatment.
GSM Differential Diagnosis Vaginitis (BV, yeast, trichomonas), contact dermatitis, lichen sclerosus, lichen
planus, vulvar cancer, vulvar masses. Requires pelvic exam for accurate
diagnosis.
Abnormal Uterine Bleeding (AUB) Any bleeding outside normal menstrual parameters. PALM-COEIN
classification: Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia
(structural); Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic, Not
classified (non-structural).
AUB Evaluation History and physical exam, pregnancy test, CBC, TSH, coagulation studies,
pelvic ultrasound, endometrial biopsy (if >45 or risk factors for hyperplasia),
hysteroscopy.
Sexual Health Changes in Menopause Decreased libido (HSDD), decreased arousal, lubrication difficulties,
dyspareunia, anorgasmia. Caused by estrogen/androgen decline, GSM,
psychosocial factors, relationship issues.
Sexual Health Treatments Local vaginal estrogen, vaginal DHEA (prasterone), ospemifene (oral SERM),
systemic HT, testosterone (off-label), pelvic floor PT, lubricants,
psychotherapy/sex therapy, vibrators.
Sleep Changes in Menopause Insomnia, sleep fragmentation, early awakening. Caused by night sweats,
circadian changes, mood disorders. Differential: restless leg syndrome (iron
deficiency), obstructive sleep apnea (increases post-menopause), primary
insomnia.
Sleep Treatment CBT-I (first-line), sleep hygiene, melatonin, HT for night sweats, gabapentin,
eszopiclone, zolpidem. Treat underlying sleep apnea (CPAP).
Cognitive and Mood Changes Perimenopausal "window of vulnerability" for depression and anxiety.
Subjective cognitive complaints common. MRI changes in brain energy
metabolism. HT may have neuroprotective effects when initiated early.
Weight Changes in Menopause Average gain ~1.5 lb/year. Central adiposity increases due to hormonal shifts
even without weight gain. Increases CVD and metabolic risk. Management:
caloric restriction, aerobic + resistance exercise, pharmacotherapy (GLP-1
agonists), bariatric surgery.
Arthralgia in Menopause Joint pain common in peri/postmenopause. Estrogen has anti-inflammatory
effects. Differential: osteoarthritis, rheumatoid arthritis, fibromyalgia, drug-
induced (AIs can cause severe joint pain). Management: NSAIDs, exercise, HT
may help.
Postmenopause The time after the final menstrual period. Early postmenopause = first ~6 years;
vasomotor symptoms most prominent. Late postmenopause = increased bone
loss and CVD risk.
STRAW+10 Staging System Stages of Reproductive Aging Workshop: Late Reproductive → Early Transition
(variable cycle length) → Late Transition (≥2 skipped cycles, ≥60-day gaps) →
Early Postmenopause (~6 yrs) → Late Postmenopause.
Dominant Symptoms by STRAW Stage Early transition: irregular cycles, premenstrual symptoms. Late transition:
skipped cycles, VMS begin. Early postmenopause: peak VMS, sleep disruption,
GSM begins. Late postmenopause: GSM, bone loss, CVD risk.
LOOP Events (Luteal Out-of-Phase) Anovulatory cycles where estrogen rises but progesterone is absent. Causes
irregular bleeding and risk of endometrial hyperplasia. Common in
perimenopause.
Fertility Changes in Perimenopause Declining ovarian reserve → rising FSH, falling inhibin B, then declining
estradiol. Anti-Müllerian hormone (AMH) declines earliest. Pregnancy is still
possible until confirmed menopause.
Premature Ovarian Insufficiency (POI) Amenorrhea + FSH >25 mIU/mL before age 40. Causes: genetic (Turner
syndrome, fragile X premutation), autoimmune, iatrogenic (chemo/radiation).
Requires hormone therapy for health protection.
Surgical Menopause Bilateral oophorectomy causes immediate estrogen loss + ~50% androgen loss.
More abrupt and severe symptoms than natural menopause. HT strongly
recommended unless contraindicated.
Clinical Consequences of Early Estrogen Loss Accelerated bone loss, increased CVD risk, cognitive effects, severe VMS,
premature GSM. In POI/surgical menopause, HT should be initiated promptly
and continued at least until average age of natural menopause (51).
DOMAIN 2: Symptoms and Concerns (20%) This domain covers 20% of the exam. Topics: weight (2%), hair (1%), sleep (2%),
sexual health (2%), breast symptoms (2%), AUB (2%), arthralgia (1%), VMS (2%),
GSM (2%), pelvic floor (2%), cognition/mood (2%).
Vasomotor Symptoms (VMS) Hot flashes and night sweats caused by narrowing of the thermoregulatory set
point. Affect ~70-80% of women. Peak in late transition and early
postmenopause. Can last >7 years on average (longer in some populations).
VMS Risk Factors Higher BMI, African American ethnicity, smoking, anxiety, depression, lower
educational level, surgical menopause. Timing and duration vary by
race/ethnicity (Study of Women's Health Across the Nation - SWAN).
, MSCP Exam Study Guide - Menopause Society Certified Practitioner
Genitourinary Syndrome of Menopause (GSM) Umbrella term for vulvovaginal and lower urinary tract symptoms due to
estrogen deficiency. Includes vaginal dryness, dyspareunia, burning, urgency,
recurrent UTIs. Unlike VMS, GSM is chronic and progressive without treatment.
GSM Differential Diagnosis Vaginitis (BV, yeast, trichomonas), contact dermatitis, lichen sclerosus, lichen
planus, vulvar cancer, vulvar masses. Requires pelvic exam for accurate
diagnosis.
Abnormal Uterine Bleeding (AUB) Any bleeding outside normal menstrual parameters. PALM-COEIN
classification: Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia
(structural); Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic, Not
classified (non-structural).
AUB Evaluation History and physical exam, pregnancy test, CBC, TSH, coagulation studies,
pelvic ultrasound, endometrial biopsy (if >45 or risk factors for hyperplasia),
hysteroscopy.
Sexual Health Changes in Menopause Decreased libido (HSDD), decreased arousal, lubrication difficulties,
dyspareunia, anorgasmia. Caused by estrogen/androgen decline, GSM,
psychosocial factors, relationship issues.
Sexual Health Treatments Local vaginal estrogen, vaginal DHEA (prasterone), ospemifene (oral SERM),
systemic HT, testosterone (off-label), pelvic floor PT, lubricants,
psychotherapy/sex therapy, vibrators.
Sleep Changes in Menopause Insomnia, sleep fragmentation, early awakening. Caused by night sweats,
circadian changes, mood disorders. Differential: restless leg syndrome (iron
deficiency), obstructive sleep apnea (increases post-menopause), primary
insomnia.
Sleep Treatment CBT-I (first-line), sleep hygiene, melatonin, HT for night sweats, gabapentin,
eszopiclone, zolpidem. Treat underlying sleep apnea (CPAP).
Cognitive and Mood Changes Perimenopausal "window of vulnerability" for depression and anxiety.
Subjective cognitive complaints common. MRI changes in brain energy
metabolism. HT may have neuroprotective effects when initiated early.
Weight Changes in Menopause Average gain ~1.5 lb/year. Central adiposity increases due to hormonal shifts
even without weight gain. Increases CVD and metabolic risk. Management:
caloric restriction, aerobic + resistance exercise, pharmacotherapy (GLP-1
agonists), bariatric surgery.
Arthralgia in Menopause Joint pain common in peri/postmenopause. Estrogen has anti-inflammatory
effects. Differential: osteoarthritis, rheumatoid arthritis, fibromyalgia, drug-
induced (AIs can cause severe joint pain). Management: NSAIDs, exercise, HT
may help.
