N A M S M E N O PA U S E C E R T I F I C AT I O N P R E P
LATEST EDITION
NAMS Menopause Certification
Exam
Questions and Answers (Graded A+)
210 Verified Questions with Detailed Evidence-Based Explanations
210 6 A+
QUESTIONS SECTIONS G R A D E Q UA L I T Y
E X A M I N AT I O N C O N T E N T B L U E P R I N T
1. Reproductive Physiology & Menopause Staging (Q1-35) 4. Treatment: Hormonal & Non-Hormonal (Q106-145)
2. Symptom Management (Q36-70) 5. Preventive Care, Counseling & Special Populations (Q146-180)
3. Health Disorders & Clinical Assessment (Q71-105) 6. Comprehensive Cases & Clinical Application (Q181-210)
The Menopause Society (formerly NAMS) Graded A+ Quality
Menopause Certification Examination Prep STRAW+10 · WHI · NAMS 2022 Position Statement
,NAMS Menopause Certification Exam | 2026/2027 Latest Edition 210 Questions | Graded A+
NAMS Menopause Certification Exam | 2026/2027
Latest Edition
Questions and Answers (Graded A+)
210 Verified Questions with Detailed Evidence-Based Explanations
Aligned with the 2026-2027 NAMS (Menopause Society) Menopause Certification Examination blueprint. This comprehensive
practice exam integrates reproductive physiology (STRAW+10), symptom management (VMS, GSM, sleep, mood, sexual
health), health disorders (cardiovascular, bone, breast, thyroid), hormonal and non-hormonal therapies, preventive care,
counseling, and clinical case application. Each question includes a detailed rationale grounded in current NAMS/Menopause
Society guidelines, WHI evidence, and the timing hypothesis.
Section 1: Reproductive Physiology and Menopause Staging (Q1-Q35)
STRAW+10, Ovarian Aging, Hormonal Changes, Menopause Definitions, & POI
Q1:
According to the STRAW+10 staging system, which stage is defined by the onset of variability in menstrual cycle length
(persistent difference of >=7 days in length of consecutive cycles)?
A. Stage -1 (Early Menopausal Transition) [CORRECT]
B. Stage -2 (Late Reproductive Stage)
C. Stage +1 (Early Postmenopause)
D. Stage 0 (Menopause)
Correct Answer: A
Rationale: STRAW+10 Stage -1 (Early Menopausal Transition) is defined by the onset of menstrual cycle
variability: a persistent difference of >=7 days in length between consecutive cycles. This is the first measurable
marker of reproductive aging. Stage -2 (Late Reproductive Stage) shows regular cycles with subtle FSH changes.
Stage +1 (Early Postmenopause) follows the final menstrual period. Stage 0 is the single point of the final
menstrual period (FMP).
Q2:
A 47-year-old G2P2 reports 2 cycles with intervals of 35 and 45 days (previously 28 days). According to STRAW+10
criteria, what stage is she in?
A. Stage -2 (Late Reproductive)
B. Stage -1 (Early Menopausal Transition) [CORRECT]
C. Stage -2b (Late Reproductive, variable cycles)
D. Stage -3 (Peak Reproductive)
Correct Answer: B
Page 1
,NAMS Menopause Certification Exam | 2026/2027 Latest Edition 210 Questions | Graded A+
Rationale: The patient meets STRAW+10 criteria for Stage -1 (Early Menopausal Transition): persistent
difference of >=7 days between consecutive cycle lengths. Her intervals of 35 then 45 days represent this
variability. Stage -2 (Late Reproductive, A) maintains regular cycles. Stage -2b (C) is not a STRAW+10
designation. Stage -3 (D) describes peak reproductive years. The transition to late menopausal transition (Stage
-2 of transition) requires intervals of >=60 days of amenorrhea.
Q3:
A 50-year-old woman has had intervals of amenorrhea >=60 days. Which STRAW+10 stage best describes her?
A. Stage -1 (Early Transition)
B. Stage -2 (Late Menopausal Transition) [CORRECT]
C. Stage +1a (Early Postmenopause, first 1-2 years)
D. Stage +1b (Early Postmenopause, years 3-8)
Correct Answer: B
Rationale: STRAW+10 Stage -2 (Late Menopausal Transition) is defined by intervals of amenorrhea >=60
days, marking increased follicle depletion and erratic hormonal patterns. Stage -1 (A) shows cycle variability
without prolonged amenorrhea. Stage +1a (C) is the first 1-2 years post-FMP. Stage +1b (D) is years 3-8
post-FMP. Late transition predicts the approach of the final menstrual period within 1-3 years.
Q4:
The final menstrual period (FMP) in STRAW+10 is designated as which stage?
A. Stage -2 (Late Transition)
B. Stage 0 (Menopause) [CORRECT]
C. Stage +1 (Early Postmenopause)
D. Stage +2 (Late Postmenopause)
Correct Answer: B
Rationale: Stage 0 in STRAW+10 represents the single time point of the Final Menstrual Period (FMP),
recognized retrospectively after 12 consecutive months of amenorrhea. It separates the menopausal transition
(Stages -1, -2) from postmenopause (Stages +1, +2). Stage -2 (A) is late transition. Stage +1 (C) is early
postmenopause following the FMP. Stage +2 (D) is late postmenopause.
Q5:
Natural menopause is defined as:
A. 12 months of amenorrhea without other pathologic cause after age 40 [CORRECT]
B. 6 months of amenorrhea with elevated FSH
C. 24 months of amenorrhea after age 45
D. Cessation of menses after surgical bilateral oophorectomy
Correct Answer: A
Page 2
, NAMS Menopause Certification Exam | 2026/2027 Latest Edition 210 Questions | Graded A+
Rationale: Natural menopause is the permanent cessation of menstruation determined retrospectively after 12
consecutive months of amenorrhea not due to other causes. The median age is 51 years (range 40-58). Six
months (B) is insufficient for diagnosis. Twenty-four months (C) is not required. Surgical menopause (D) refers
to menopause induced by bilateral oophorectomy, not natural menopause.
Q6:
Early menopause refers to menopause that occurs between which ages?
A. Before age 40
B. Between ages 40 and 45 [CORRECT]
C. Between ages 45 and 50
D. After age 55
Correct Answer: B
Rationale: Per the International Menopause Society and NAMS, early menopause refers to menopause
occurring between ages 40 and 45. Menopause before age 40 (A) is defined as primary ovarian insufficiency
(POI), not early menopause. Menopause between 45 and 50 (C) falls within the normal range. Menopause after
55 (D) is late menopause. Early menopause carries increased risks of cardiovascular disease and osteoporosis.
Q7:
Primary ovarian insufficiency (POI) is defined as:
A. Menopause after age 45
B. Ovarian insufficiency before age 40 with at least 4 months of amenorrhea and two FSH levels in menopausal range
[CORRECT]
C. Surgical menopause before age 45
D. Perimenopause with hot flashes before age 45
Correct Answer: B
Rationale: POI is defined as ovarian dysfunction before age 40 with at least 4 months of amenorrhea and two
serum FSH levels in menopausal range (>25 IU/L per ESHRE/IMS or >40 IU/L per older ACOG criteria)
measured at least 4 weeks apart. Unlike menopause, POI may have intermittent ovarian function and ~5-10%
spontaneous pregnancy rate. Early menopause (A) is 40-45. Surgical menopause (C) is iatrogenic. Symptoms
alone (D) are insufficient for diagnosis.
Q8:
Which hormonal change is the EARLIEST biochemical marker of reproductive aging, often preceding menstrual cycle
changes?
A. Elevated luteinizing hormone (LH)
B. Decreased inhibin B in the early follicular phase [CORRECT]
C. Markedly elevated estradiol
D. Elevated anti-Mullerian hormone (AMH)
Correct Answer: B
Page 3
LATEST EDITION
NAMS Menopause Certification
Exam
Questions and Answers (Graded A+)
210 Verified Questions with Detailed Evidence-Based Explanations
210 6 A+
QUESTIONS SECTIONS G R A D E Q UA L I T Y
E X A M I N AT I O N C O N T E N T B L U E P R I N T
1. Reproductive Physiology & Menopause Staging (Q1-35) 4. Treatment: Hormonal & Non-Hormonal (Q106-145)
2. Symptom Management (Q36-70) 5. Preventive Care, Counseling & Special Populations (Q146-180)
3. Health Disorders & Clinical Assessment (Q71-105) 6. Comprehensive Cases & Clinical Application (Q181-210)
The Menopause Society (formerly NAMS) Graded A+ Quality
Menopause Certification Examination Prep STRAW+10 · WHI · NAMS 2022 Position Statement
,NAMS Menopause Certification Exam | 2026/2027 Latest Edition 210 Questions | Graded A+
NAMS Menopause Certification Exam | 2026/2027
Latest Edition
Questions and Answers (Graded A+)
210 Verified Questions with Detailed Evidence-Based Explanations
Aligned with the 2026-2027 NAMS (Menopause Society) Menopause Certification Examination blueprint. This comprehensive
practice exam integrates reproductive physiology (STRAW+10), symptom management (VMS, GSM, sleep, mood, sexual
health), health disorders (cardiovascular, bone, breast, thyroid), hormonal and non-hormonal therapies, preventive care,
counseling, and clinical case application. Each question includes a detailed rationale grounded in current NAMS/Menopause
Society guidelines, WHI evidence, and the timing hypothesis.
Section 1: Reproductive Physiology and Menopause Staging (Q1-Q35)
STRAW+10, Ovarian Aging, Hormonal Changes, Menopause Definitions, & POI
Q1:
According to the STRAW+10 staging system, which stage is defined by the onset of variability in menstrual cycle length
(persistent difference of >=7 days in length of consecutive cycles)?
A. Stage -1 (Early Menopausal Transition) [CORRECT]
B. Stage -2 (Late Reproductive Stage)
C. Stage +1 (Early Postmenopause)
D. Stage 0 (Menopause)
Correct Answer: A
Rationale: STRAW+10 Stage -1 (Early Menopausal Transition) is defined by the onset of menstrual cycle
variability: a persistent difference of >=7 days in length between consecutive cycles. This is the first measurable
marker of reproductive aging. Stage -2 (Late Reproductive Stage) shows regular cycles with subtle FSH changes.
Stage +1 (Early Postmenopause) follows the final menstrual period. Stage 0 is the single point of the final
menstrual period (FMP).
Q2:
A 47-year-old G2P2 reports 2 cycles with intervals of 35 and 45 days (previously 28 days). According to STRAW+10
criteria, what stage is she in?
A. Stage -2 (Late Reproductive)
B. Stage -1 (Early Menopausal Transition) [CORRECT]
C. Stage -2b (Late Reproductive, variable cycles)
D. Stage -3 (Peak Reproductive)
Correct Answer: B
Page 1
,NAMS Menopause Certification Exam | 2026/2027 Latest Edition 210 Questions | Graded A+
Rationale: The patient meets STRAW+10 criteria for Stage -1 (Early Menopausal Transition): persistent
difference of >=7 days between consecutive cycle lengths. Her intervals of 35 then 45 days represent this
variability. Stage -2 (Late Reproductive, A) maintains regular cycles. Stage -2b (C) is not a STRAW+10
designation. Stage -3 (D) describes peak reproductive years. The transition to late menopausal transition (Stage
-2 of transition) requires intervals of >=60 days of amenorrhea.
Q3:
A 50-year-old woman has had intervals of amenorrhea >=60 days. Which STRAW+10 stage best describes her?
A. Stage -1 (Early Transition)
B. Stage -2 (Late Menopausal Transition) [CORRECT]
C. Stage +1a (Early Postmenopause, first 1-2 years)
D. Stage +1b (Early Postmenopause, years 3-8)
Correct Answer: B
Rationale: STRAW+10 Stage -2 (Late Menopausal Transition) is defined by intervals of amenorrhea >=60
days, marking increased follicle depletion and erratic hormonal patterns. Stage -1 (A) shows cycle variability
without prolonged amenorrhea. Stage +1a (C) is the first 1-2 years post-FMP. Stage +1b (D) is years 3-8
post-FMP. Late transition predicts the approach of the final menstrual period within 1-3 years.
Q4:
The final menstrual period (FMP) in STRAW+10 is designated as which stage?
A. Stage -2 (Late Transition)
B. Stage 0 (Menopause) [CORRECT]
C. Stage +1 (Early Postmenopause)
D. Stage +2 (Late Postmenopause)
Correct Answer: B
Rationale: Stage 0 in STRAW+10 represents the single time point of the Final Menstrual Period (FMP),
recognized retrospectively after 12 consecutive months of amenorrhea. It separates the menopausal transition
(Stages -1, -2) from postmenopause (Stages +1, +2). Stage -2 (A) is late transition. Stage +1 (C) is early
postmenopause following the FMP. Stage +2 (D) is late postmenopause.
Q5:
Natural menopause is defined as:
A. 12 months of amenorrhea without other pathologic cause after age 40 [CORRECT]
B. 6 months of amenorrhea with elevated FSH
C. 24 months of amenorrhea after age 45
D. Cessation of menses after surgical bilateral oophorectomy
Correct Answer: A
Page 2
, NAMS Menopause Certification Exam | 2026/2027 Latest Edition 210 Questions | Graded A+
Rationale: Natural menopause is the permanent cessation of menstruation determined retrospectively after 12
consecutive months of amenorrhea not due to other causes. The median age is 51 years (range 40-58). Six
months (B) is insufficient for diagnosis. Twenty-four months (C) is not required. Surgical menopause (D) refers
to menopause induced by bilateral oophorectomy, not natural menopause.
Q6:
Early menopause refers to menopause that occurs between which ages?
A. Before age 40
B. Between ages 40 and 45 [CORRECT]
C. Between ages 45 and 50
D. After age 55
Correct Answer: B
Rationale: Per the International Menopause Society and NAMS, early menopause refers to menopause
occurring between ages 40 and 45. Menopause before age 40 (A) is defined as primary ovarian insufficiency
(POI), not early menopause. Menopause between 45 and 50 (C) falls within the normal range. Menopause after
55 (D) is late menopause. Early menopause carries increased risks of cardiovascular disease and osteoporosis.
Q7:
Primary ovarian insufficiency (POI) is defined as:
A. Menopause after age 45
B. Ovarian insufficiency before age 40 with at least 4 months of amenorrhea and two FSH levels in menopausal range
[CORRECT]
C. Surgical menopause before age 45
D. Perimenopause with hot flashes before age 45
Correct Answer: B
Rationale: POI is defined as ovarian dysfunction before age 40 with at least 4 months of amenorrhea and two
serum FSH levels in menopausal range (>25 IU/L per ESHRE/IMS or >40 IU/L per older ACOG criteria)
measured at least 4 weeks apart. Unlike menopause, POI may have intermittent ovarian function and ~5-10%
spontaneous pregnancy rate. Early menopause (A) is 40-45. Surgical menopause (C) is iatrogenic. Symptoms
alone (D) are insufficient for diagnosis.
Q8:
Which hormonal change is the EARLIEST biochemical marker of reproductive aging, often preceding menstrual cycle
changes?
A. Elevated luteinizing hormone (LH)
B. Decreased inhibin B in the early follicular phase [CORRECT]
C. Markedly elevated estradiol
D. Elevated anti-Mullerian hormone (AMH)
Correct Answer: B
Page 3
