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NAMS MENOPAUSE CERTIFICATION PRACTICE EXAM Evidence-
Based Solutions | 2026/2027 Edition | Version 2 Total
Questions: 100 | Graded A+ Q&A
Content Areas:
• Menopause Staging & Physiology
• Vasomotor Symptoms (VMS)
• Genitourinary Syndrome of Menopause (GSM)
• Hormone Therapy (HT)
• Nonhormonal Therapies
• Bone Health & Osteoporosis
• Cardiovascular & Metabolic Considerations
• Breast & Endometrial Safety
• Premature/Primary Ovarian Insufficiency (POI)
• Special Populations & Shared Decision-Making
SECTION 1: MENOPAUSE STAGING & PHYSIOLOGY
Question 1
According to the STRAW+10 staging system, which of the
following characterizes the early menopausal transition?
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A. Persistent ≥7-day change in menstrual cycle length
B. ≥60 days of amenorrhea
C. 12 months of amenorrhea
D. FSH >40 mIU/mL
E. Onset of hot flashes
Answer: A
Rationale: The early menopausal transition is characterized by a
persistent difference of ≥7 days in menstrual cycle length. Late
transition includes ≥60 days of amenorrhea. Postmenopause
begins after 12 months of amenorrhea.
Question 2
A 48-year-old woman reports that her cycles have become
shorter, from 28 days to 21 days. What is the most likely cause?
A. Anovulatory cycles with decreased inhibin B and rising FSH
B. Pregnancy
C. Hypothyroidism
D. Polycystic ovary syndrome
E. Endometrial hyperplasia
Answer: A
Rationale: Shortening of menstrual cycles is a common early
menopausal change due to declining follicular function,
reduced inhibin B, and increased FSH.
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Question 3
Which of the following is the most accurate statement about
estradiol levels during the menopausal transition?
A. Estradiol levels are consistently high
B. Estradiol levels fluctuate widely and may be normal or high
early in the transition
C. Estradiol is always low
D. Estradiol is the best marker for menopause
E. Estradiol levels are unaffected
Answer: B
Rationale: During the menopausal transition, estradiol levels
fluctuate unpredictably and may even be elevated due to luteal
out-of-phase (LOOP) events. FSH is a better marker for ovarian
aging but also fluctuates.
Question 4
A 52-year-old woman with an intact uterus and 10 months of
amenorrhea reports hot flashes. Which of the following is the
most appropriate diagnostic approach?
A. FSH and estradiol levels
B. Clinical diagnosis based on age and symptoms
C. Pelvic ultrasound
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D. Endometrial biopsy
E. Progesterone challenge test
Answer: B
Rationale: In a woman >45 with typical menopausal symptoms
and amenorrhea, menopause is a clinical diagnosis. Hormone
testing is not generally needed.
Question 5
Which of the following is a systemic effect of estrogen
deficiency?
A. Increased skin collagen
B. Increased bone resorption
C. Decreased LDL cholesterol
D. Increased HDL cholesterol
E. Decreased triglycerides
Answer: B
Rationale: Estrogen deficiency leads to increased bone
resorption and accelerated bone loss. It also may unfavorably
affect lipids (increase LDL, decrease HDL) in some women.
Question 6
A woman who has undergone bilateral oophorectomy at age 45
is considered:
NAMS MENOPAUSE CERTIFICATION PRACTICE EXAM Evidence-
Based Solutions | 2026/2027 Edition | Version 2 Total
Questions: 100 | Graded A+ Q&A
Content Areas:
• Menopause Staging & Physiology
• Vasomotor Symptoms (VMS)
• Genitourinary Syndrome of Menopause (GSM)
• Hormone Therapy (HT)
• Nonhormonal Therapies
• Bone Health & Osteoporosis
• Cardiovascular & Metabolic Considerations
• Breast & Endometrial Safety
• Premature/Primary Ovarian Insufficiency (POI)
• Special Populations & Shared Decision-Making
SECTION 1: MENOPAUSE STAGING & PHYSIOLOGY
Question 1
According to the STRAW+10 staging system, which of the
following characterizes the early menopausal transition?
, Page |2
A. Persistent ≥7-day change in menstrual cycle length
B. ≥60 days of amenorrhea
C. 12 months of amenorrhea
D. FSH >40 mIU/mL
E. Onset of hot flashes
Answer: A
Rationale: The early menopausal transition is characterized by a
persistent difference of ≥7 days in menstrual cycle length. Late
transition includes ≥60 days of amenorrhea. Postmenopause
begins after 12 months of amenorrhea.
Question 2
A 48-year-old woman reports that her cycles have become
shorter, from 28 days to 21 days. What is the most likely cause?
A. Anovulatory cycles with decreased inhibin B and rising FSH
B. Pregnancy
C. Hypothyroidism
D. Polycystic ovary syndrome
E. Endometrial hyperplasia
Answer: A
Rationale: Shortening of menstrual cycles is a common early
menopausal change due to declining follicular function,
reduced inhibin B, and increased FSH.
, Page |3
Question 3
Which of the following is the most accurate statement about
estradiol levels during the menopausal transition?
A. Estradiol levels are consistently high
B. Estradiol levels fluctuate widely and may be normal or high
early in the transition
C. Estradiol is always low
D. Estradiol is the best marker for menopause
E. Estradiol levels are unaffected
Answer: B
Rationale: During the menopausal transition, estradiol levels
fluctuate unpredictably and may even be elevated due to luteal
out-of-phase (LOOP) events. FSH is a better marker for ovarian
aging but also fluctuates.
Question 4
A 52-year-old woman with an intact uterus and 10 months of
amenorrhea reports hot flashes. Which of the following is the
most appropriate diagnostic approach?
A. FSH and estradiol levels
B. Clinical diagnosis based on age and symptoms
C. Pelvic ultrasound
, Page |4
D. Endometrial biopsy
E. Progesterone challenge test
Answer: B
Rationale: In a woman >45 with typical menopausal symptoms
and amenorrhea, menopause is a clinical diagnosis. Hormone
testing is not generally needed.
Question 5
Which of the following is a systemic effect of estrogen
deficiency?
A. Increased skin collagen
B. Increased bone resorption
C. Decreased LDL cholesterol
D. Increased HDL cholesterol
E. Decreased triglycerides
Answer: B
Rationale: Estrogen deficiency leads to increased bone
resorption and accelerated bone loss. It also may unfavorably
affect lipids (increase LDL, decrease HDL) in some women.
Question 6
A woman who has undergone bilateral oophorectomy at age 45
is considered:
