Accurate Exam Coverage Area
Main Topic: Menopause Management and Women's Health
1. Physiology of Reproductive Aging & Menopause Transition —
STRAW+10 staging criteria, definitions of
menopause/perimenopause/postmenopause, hypothalamic-pituitary-
ovarian axis changes, follicular depletion, hormonal patterns (FSH,
estradiol, inhibin B), average age of natural menopause (51-52 years),
premature ovarian insufficiency (before age 40).
2. Vasomotor Symptoms (VMS) — Prevalence (~75-80%),
pathophysiology (thermoregulatory dysfunction from estrogen
withdrawal), duration (2-5 minutes per episode), impact on sleep and
quality of life, distinction between hot flashes and night sweats.
3. Genitourinary Syndrome of Menopause (GSM) — Vaginal dryness,
dyspareunia, recurrent UTIs, vaginal pH changes, pathophysiology of
, estrogen deficiency on urogenital tissues, distinction from infectious
vaginitis.
4. Hormone Therapy (HT) — Indications, Contraindications, and
Regimens — Systemic vs. local estrogen, progestogen requirement
for endometrial protection in women with a uterus, absolute
contraindications (breast cancer history, VTE, undiagnosed bleeding,
liver disease), window of opportunity hypothesis (<60 years or within
10 years of menopause), transdermal vs. oral routes, estrogen-alone
after hysterectomy.
5. Non-Hormonal Management of VMS — FDA-approved paroxetine
mesylate (7.5 mg), off-label SSRIs/SNRIs (venlafaxine, escitalopram),
gabapentin, fezolinetant (NK3 receptor antagonist), CBT and clinical
hypnosis, contraindications to HT driving non-hormonal selection.
6. Bone Health & Osteoporosis — DEXA screening (age 65+ or younger
with risk factors), T-score interpretation (osteopenia -1.0 to -2.5,
, osteoporosis ≤ -2.5), calcium/vitamin D, weight-bearing exercise,
bisphosphonates, SERMs, denosumab, MHT as bone-protective
option.
7. Cardiovascular Health & Metabolic Changes — Timing hypothesis for
HT and CV risk, differential VTE risk with oral vs. transdermal
estrogen, lipid effects, blood pressure considerations, smoking as a
risk modifier.
8. Sexual Health & Mood — Hypoactive sexual desire disorder,
dyspareunia from GSM, impact of mood disorders on menopause
symptoms, depression screening, treatment considerations (including
bupropion for sexual side effects).
9. Special Populations & Clinical Scenarios — Surgical menopause
(abrupt estrogen loss, estrogen-alone therapy), premature ovarian
insufficiency (POI), breast cancer survivors with GSM (vaginal
, estrogen vs. non-hormonal options like ospemifene, prasterone),
women with contraindications to HT.
10. Preventive Care & Counseling — Lifestyle modification, weight
management, smoking cessation, screening recommendations
(mammography, colon cancer, bone density), patient education on
HT risks/benefits, shared decision-making.
NAMS Menopause Certification Exam
1. A 52-year-old woman reports her last menstrual period was 14
months ago. She has hot flashes and vaginal dryness. Which term best
describes her current reproductive stage?
Main Topic: Menopause Management and Women's Health
1. Physiology of Reproductive Aging & Menopause Transition —
STRAW+10 staging criteria, definitions of
menopause/perimenopause/postmenopause, hypothalamic-pituitary-
ovarian axis changes, follicular depletion, hormonal patterns (FSH,
estradiol, inhibin B), average age of natural menopause (51-52 years),
premature ovarian insufficiency (before age 40).
2. Vasomotor Symptoms (VMS) — Prevalence (~75-80%),
pathophysiology (thermoregulatory dysfunction from estrogen
withdrawal), duration (2-5 minutes per episode), impact on sleep and
quality of life, distinction between hot flashes and night sweats.
3. Genitourinary Syndrome of Menopause (GSM) — Vaginal dryness,
dyspareunia, recurrent UTIs, vaginal pH changes, pathophysiology of
, estrogen deficiency on urogenital tissues, distinction from infectious
vaginitis.
4. Hormone Therapy (HT) — Indications, Contraindications, and
Regimens — Systemic vs. local estrogen, progestogen requirement
for endometrial protection in women with a uterus, absolute
contraindications (breast cancer history, VTE, undiagnosed bleeding,
liver disease), window of opportunity hypothesis (<60 years or within
10 years of menopause), transdermal vs. oral routes, estrogen-alone
after hysterectomy.
5. Non-Hormonal Management of VMS — FDA-approved paroxetine
mesylate (7.5 mg), off-label SSRIs/SNRIs (venlafaxine, escitalopram),
gabapentin, fezolinetant (NK3 receptor antagonist), CBT and clinical
hypnosis, contraindications to HT driving non-hormonal selection.
6. Bone Health & Osteoporosis — DEXA screening (age 65+ or younger
with risk factors), T-score interpretation (osteopenia -1.0 to -2.5,
, osteoporosis ≤ -2.5), calcium/vitamin D, weight-bearing exercise,
bisphosphonates, SERMs, denosumab, MHT as bone-protective
option.
7. Cardiovascular Health & Metabolic Changes — Timing hypothesis for
HT and CV risk, differential VTE risk with oral vs. transdermal
estrogen, lipid effects, blood pressure considerations, smoking as a
risk modifier.
8. Sexual Health & Mood — Hypoactive sexual desire disorder,
dyspareunia from GSM, impact of mood disorders on menopause
symptoms, depression screening, treatment considerations (including
bupropion for sexual side effects).
9. Special Populations & Clinical Scenarios — Surgical menopause
(abrupt estrogen loss, estrogen-alone therapy), premature ovarian
insufficiency (POI), breast cancer survivors with GSM (vaginal
, estrogen vs. non-hormonal options like ospemifene, prasterone),
women with contraindications to HT.
10. Preventive Care & Counseling — Lifestyle modification, weight
management, smoking cessation, screening recommendations
(mammography, colon cancer, bone density), patient education on
HT risks/benefits, shared decision-making.
NAMS Menopause Certification Exam
1. A 52-year-old woman reports her last menstrual period was 14
months ago. She has hot flashes and vaginal dryness. Which term best
describes her current reproductive stage?
