NAMS MENOPAUSE CERTIFICATION END OF COURSE
2025/2026 QUESTIONS WITH ANSWERS GRADED A+
✔✔What are the 3 main differences in estrogen of transdermal estrogens? - ✔✔Lower
VTE risk (veinous thromboembolism)
No impact on triglycerides
Potential lower stroke risk. so lower blood clot risk
✔✔What are the 2 main differences in estrogen of oral estrogens - ✔✔Increases
triglycerides
Potential for decreased libido
✔✔What is the Women's Health Initiative (WHI)? - ✔✔Clinical study started in 1991.
Studied the use of conjugated equine estrogens (CEE) and medroxyprogesterone
acetate (MPA) in women with and without a uterus
✔✔What was the most important "shocking" result from the WHI? - ✔✔Estrogen +
progestin combo resulted in an increased risk of breast cancer
✔✔What was the problem with how the WHI ended - ✔✔There was some bias in the
study, since it stopped early. Upon further investigation 18 years later, increased
mortality was not associated with hormone therapy. Women would have less side
effects over time
✔✔When is it considered safe to start menopause hormone therapy (MHT) in women? -
✔✔Likely safe to start in patients with no contraindications who are within 10 years of
menopause, and/or <60 years old according to NAMS
✔✔Is tobacco use a contraindication to MHT - ✔✔Tobacco use is NOT a
contraindication to hormone therapy, but transdermal therapy may be preferred
✔✔What is the 1st line of treatment to help with VMS of menopause after trying
nonpharmcologic therapies - ✔✔Systemic hormone therapy (HT) since it provides
optimal relief of hot flashes
✔✔What symptoms shold be present for a woman to be on HT? - ✔✔VMS
✔✔If patients have vaginal symptoms only, only use what kind of products - ✔✔vaginal
products
✔✔What are the 2 most common estrogens used in HT? - ✔✔Estradiol and Conjugated
equine estrogens (CEE)
, ✔✔What are the two most common progestogens used in HT -
✔✔Medroxyprogesterone acetate (MPA) and Micronized progesterone (MP)
✔✔What hormone should be used with caution in patients with a peanut allergy -
✔✔Micronized Progesterone (MP)
✔✔What are all of the contraindications to MHT? - ✔✔-History/concern for breast
cancer
-Estrogen-sensitive malignancies
-Undiagnosed genital bleeding
-Untreated endometrial hyperplasia
-Past idiopathic or current DVT/PE
-Active or recent arterial thrombolic disease (stroke or MI)
-Uncontrolled hypertension >140/90
-Active liver disease
-Porphyria cutanea tarda (skin condition more sensitive to bruising)
✔✔What are the nonhormonal medications that can be used to treat VMS? - ✔✔SSRIs,
SNRIs, Clonidine, Gabapentin, Pregabalin
✔✔What SSRI should be used if the patient is taking Tamoxifen for breast cancer -
✔✔Escitalopram
✔✔Which 2 SSRIs should be avoided in patients taking Tamoxifen - ✔✔Fluoxetine,
Paroxetine
✔✔Which formulation of estrogen may be favored in patients that smoke - ✔✔Estradiol
patches
✔✔Are compounded hormones recommended? - ✔✔Compounded hormones/plant-
derived hormones are not recommended by the guidelines. Lack of FDA oversight,
variability in dosing and absorption, conventional hormone therapy preferred
✔✔What are Genitourinary Syndromes of Menopause (GSM)? - ✔✔Genital, sexual and
urinary symptoms
✔✔What is the ideal first step for patients with urinary symptoms of GMS - ✔✔pelvic
floor therapy
✔✔What therapy is recommended for vaginal dryness/irritation/pain GMS symptoms -
✔✔Nonpharmacological gel or vaginal moisturizer/lubricant like Replens
✔✔What is the name of the 1st line therapy vaginal moisturizer/lubricant - ✔✔Replens
2025/2026 QUESTIONS WITH ANSWERS GRADED A+
✔✔What are the 3 main differences in estrogen of transdermal estrogens? - ✔✔Lower
VTE risk (veinous thromboembolism)
No impact on triglycerides
Potential lower stroke risk. so lower blood clot risk
✔✔What are the 2 main differences in estrogen of oral estrogens - ✔✔Increases
triglycerides
Potential for decreased libido
✔✔What is the Women's Health Initiative (WHI)? - ✔✔Clinical study started in 1991.
Studied the use of conjugated equine estrogens (CEE) and medroxyprogesterone
acetate (MPA) in women with and without a uterus
✔✔What was the most important "shocking" result from the WHI? - ✔✔Estrogen +
progestin combo resulted in an increased risk of breast cancer
✔✔What was the problem with how the WHI ended - ✔✔There was some bias in the
study, since it stopped early. Upon further investigation 18 years later, increased
mortality was not associated with hormone therapy. Women would have less side
effects over time
✔✔When is it considered safe to start menopause hormone therapy (MHT) in women? -
✔✔Likely safe to start in patients with no contraindications who are within 10 years of
menopause, and/or <60 years old according to NAMS
✔✔Is tobacco use a contraindication to MHT - ✔✔Tobacco use is NOT a
contraindication to hormone therapy, but transdermal therapy may be preferred
✔✔What is the 1st line of treatment to help with VMS of menopause after trying
nonpharmcologic therapies - ✔✔Systemic hormone therapy (HT) since it provides
optimal relief of hot flashes
✔✔What symptoms shold be present for a woman to be on HT? - ✔✔VMS
✔✔If patients have vaginal symptoms only, only use what kind of products - ✔✔vaginal
products
✔✔What are the 2 most common estrogens used in HT? - ✔✔Estradiol and Conjugated
equine estrogens (CEE)
, ✔✔What are the two most common progestogens used in HT -
✔✔Medroxyprogesterone acetate (MPA) and Micronized progesterone (MP)
✔✔What hormone should be used with caution in patients with a peanut allergy -
✔✔Micronized Progesterone (MP)
✔✔What are all of the contraindications to MHT? - ✔✔-History/concern for breast
cancer
-Estrogen-sensitive malignancies
-Undiagnosed genital bleeding
-Untreated endometrial hyperplasia
-Past idiopathic or current DVT/PE
-Active or recent arterial thrombolic disease (stroke or MI)
-Uncontrolled hypertension >140/90
-Active liver disease
-Porphyria cutanea tarda (skin condition more sensitive to bruising)
✔✔What are the nonhormonal medications that can be used to treat VMS? - ✔✔SSRIs,
SNRIs, Clonidine, Gabapentin, Pregabalin
✔✔What SSRI should be used if the patient is taking Tamoxifen for breast cancer -
✔✔Escitalopram
✔✔Which 2 SSRIs should be avoided in patients taking Tamoxifen - ✔✔Fluoxetine,
Paroxetine
✔✔Which formulation of estrogen may be favored in patients that smoke - ✔✔Estradiol
patches
✔✔Are compounded hormones recommended? - ✔✔Compounded hormones/plant-
derived hormones are not recommended by the guidelines. Lack of FDA oversight,
variability in dosing and absorption, conventional hormone therapy preferred
✔✔What are Genitourinary Syndromes of Menopause (GSM)? - ✔✔Genital, sexual and
urinary symptoms
✔✔What is the ideal first step for patients with urinary symptoms of GMS - ✔✔pelvic
floor therapy
✔✔What therapy is recommended for vaginal dryness/irritation/pain GMS symptoms -
✔✔Nonpharmacological gel or vaginal moisturizer/lubricant like Replens
✔✔What is the name of the 1st line therapy vaginal moisturizer/lubricant - ✔✔Replens
