, NAMS MENOPAUSE STUDY GUIDE NCMP
EXAM PREP (2024-2025)
130 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Synthesize complex hormonal changes and their systemic effects during the menopause transition
2 Evaluate evidence for pharmacological and non-pharmacological interventions in menopause
management
3 Apply risk stratification and clinical guidelines to manage menopausal symptoms and prevent chronic
disease
4 Critically appraise emerging therapies and controversies in menopause care
5 NAMS Menopause Study Guide NCMP Exam Prep
6 2024
7 2025
8 Foundations of Menopause Medicine and NCMP Exam Preparation
9 Applied Menopause Medicine and NCMP Exam Preparation
10 Advanced Menopause Medicine and NCMP Exam Preparation
11 Menopause Medicine and NCMP Exam Preparation Review
Page 1
,Q1 SYNTHESIZE COMPLEX HORMONAL CHANGES AND THEIR SYSTEMIC EFFECTS DURING
THE MENOPAUSE TRANSITION
Which physiological mechanism most accurately explains the rise in FSH
observed during the late menopausal transition, even before the final menstrual
period?
A. Decreased inhibin B secretion from declining ovarian follicular reserve, reducing negative
feedback on the pituitary CORRECT
B. Primary pituitary failure causing compensatory ovarian hyperstimulation
C. Increased hypothalamic GnRH pulse frequency due to elevated circulating estrogen
D. Diminished ovarian androgen production leading to altered steroid feedback on the
hypothalamus
RATIONALE: The primary driver of FSH elevation in the late transition is the decline in inhibin B,
which is a direct product of granulosa cells of developing follicles. Reduced inhibin B lessens
negative feedback at the pituitary, increasing FSH secretion. Pituitary failure would reduce FSH,
not increase it. Elevated estrogen would suppress FSH, not raise it. Androgens do not directly
regulate FSH in this manner.
Q2 SYNTHESIZE COMPLEX HORMONAL CHANGES AND THEIR SYSTEMIC EFFECTS DURING
THE MENOPAUSE TRANSITION
A perimenopausal individual presents with vasomotor symptoms and asks about
over-the-counter options. Which botanical preparation has the most robust
evidence for modest efficacy in reducing hot flash frequency?
A. Black cohosh (Actaea racemosa) CORRECT
B. Dong quai (Angelica sinensis)
C. Red clover isoflavones (Trifolium pratense)
D. Evening primrose oil (Oenothera biennis)
RATIONALE: Black cohosh has shown modest benefit in some randomized trials and is one of
the most studied botanicals for vasomotor symptoms, though evidence is mixed. Dong quai alone
is ineffective; red clover isoflavones show minimal to no benefit; evening primrose oil lacks
evidence for hot flash relief. Thus, black cohosh is the best-supported choice among these.
Page 2
, Q3 SYNTHESIZE COMPLEX HORMONAL CHANGES AND THEIR SYSTEMIC EFFECTS DURING
THE MENOPAUSE TRANSITION
A 52-year-old with a uterus desires menopausal hormone therapy (MHT) for
bothersome vasomotor symptoms. Which regimen is preferred to minimize
endometrial cancer risk?
A. Oral conjugated equine estrogens (CEE) 0.625 mg daily with continuous
medroxyprogesterone acetate (MPA) 2.5 mg daily CORRECT
B. Oral CEE 0.625 mg daily alone
C. Transdermal estradiol 0.05 mg daily with micronized progesterone 200 mg administered
cyclically 12 days per month
D. Oral estradiol 1 mg daily with a levonorgestrel-releasing intrauterine system (IUD)
RATIONALE: For a woman with a uterus, estrogen must be combined with a progestogen to
prevent endometrial hyperplasia and cancer. Continuous combined therapy (option A) is standard
and provides endometrial protection. Option B is contraindicated without progestogen. Option C
uses cyclic progesterone which is acceptable but not preferred over continuous for simplicity;
option D is also acceptable, but option A is the most clearly correct as a standard regimen.
However, all except B are valid; the question asks 'preferred'-continuous combined is the most
common and effective. Among the options, A is the classic regimen.
Page 3
EXAM PREP (2024-2025)
130 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Synthesize complex hormonal changes and their systemic effects during the menopause transition
2 Evaluate evidence for pharmacological and non-pharmacological interventions in menopause
management
3 Apply risk stratification and clinical guidelines to manage menopausal symptoms and prevent chronic
disease
4 Critically appraise emerging therapies and controversies in menopause care
5 NAMS Menopause Study Guide NCMP Exam Prep
6 2024
7 2025
8 Foundations of Menopause Medicine and NCMP Exam Preparation
9 Applied Menopause Medicine and NCMP Exam Preparation
10 Advanced Menopause Medicine and NCMP Exam Preparation
11 Menopause Medicine and NCMP Exam Preparation Review
Page 1
,Q1 SYNTHESIZE COMPLEX HORMONAL CHANGES AND THEIR SYSTEMIC EFFECTS DURING
THE MENOPAUSE TRANSITION
Which physiological mechanism most accurately explains the rise in FSH
observed during the late menopausal transition, even before the final menstrual
period?
A. Decreased inhibin B secretion from declining ovarian follicular reserve, reducing negative
feedback on the pituitary CORRECT
B. Primary pituitary failure causing compensatory ovarian hyperstimulation
C. Increased hypothalamic GnRH pulse frequency due to elevated circulating estrogen
D. Diminished ovarian androgen production leading to altered steroid feedback on the
hypothalamus
RATIONALE: The primary driver of FSH elevation in the late transition is the decline in inhibin B,
which is a direct product of granulosa cells of developing follicles. Reduced inhibin B lessens
negative feedback at the pituitary, increasing FSH secretion. Pituitary failure would reduce FSH,
not increase it. Elevated estrogen would suppress FSH, not raise it. Androgens do not directly
regulate FSH in this manner.
Q2 SYNTHESIZE COMPLEX HORMONAL CHANGES AND THEIR SYSTEMIC EFFECTS DURING
THE MENOPAUSE TRANSITION
A perimenopausal individual presents with vasomotor symptoms and asks about
over-the-counter options. Which botanical preparation has the most robust
evidence for modest efficacy in reducing hot flash frequency?
A. Black cohosh (Actaea racemosa) CORRECT
B. Dong quai (Angelica sinensis)
C. Red clover isoflavones (Trifolium pratense)
D. Evening primrose oil (Oenothera biennis)
RATIONALE: Black cohosh has shown modest benefit in some randomized trials and is one of
the most studied botanicals for vasomotor symptoms, though evidence is mixed. Dong quai alone
is ineffective; red clover isoflavones show minimal to no benefit; evening primrose oil lacks
evidence for hot flash relief. Thus, black cohosh is the best-supported choice among these.
Page 2
, Q3 SYNTHESIZE COMPLEX HORMONAL CHANGES AND THEIR SYSTEMIC EFFECTS DURING
THE MENOPAUSE TRANSITION
A 52-year-old with a uterus desires menopausal hormone therapy (MHT) for
bothersome vasomotor symptoms. Which regimen is preferred to minimize
endometrial cancer risk?
A. Oral conjugated equine estrogens (CEE) 0.625 mg daily with continuous
medroxyprogesterone acetate (MPA) 2.5 mg daily CORRECT
B. Oral CEE 0.625 mg daily alone
C. Transdermal estradiol 0.05 mg daily with micronized progesterone 200 mg administered
cyclically 12 days per month
D. Oral estradiol 1 mg daily with a levonorgestrel-releasing intrauterine system (IUD)
RATIONALE: For a woman with a uterus, estrogen must be combined with a progestogen to
prevent endometrial hyperplasia and cancer. Continuous combined therapy (option A) is standard
and provides endometrial protection. Option B is contraindicated without progestogen. Option C
uses cyclic progesterone which is acceptable but not preferred over continuous for simplicity;
option D is also acceptable, but option A is the most clearly correct as a standard regimen.
However, all except B are valid; the question asks 'preferred'-continuous combined is the most
common and effective. Among the options, A is the classic regimen.
Page 3
