NAMs Menopause Certification Exam (ALL 11 EXAM LATEST VERSIONS BUNDLE TOGETHER FOR NAMs EXAM): 2025/2026 UPDATE EXAM GUIDE REVIEW QUESTIONS WITH ALL CORRECT ANSWERS| PASSED & REWORDED GRADE A+

NAMS Menopause Certification Exam Practice, NAMs Menopause Certification Study Guide, NAMS Certification Exam, 2025 - NAMS Menopause Certification Exam Study Set, Menopause Society Exam: Key Quiz, NAMS Certification Test, NAMs Menopause Cert Exam 2025, NAMS Menopause Certification Exam 2025, NAMs Menopause Certification Exam Review All Versions Exam  NAMS Menopause Certification Exam Practice 102 Questions and Answer Key  NAMs Menopause Certification Study Guide 257 Questions and Answer Key  NAMS Certification Exam 121 Questions and Answer Key  2025 - NAMS Menopause Certification Exam Study Set 385 Questions and Answer Key  Menopause Society Exam: Key Quiz 120 Questions and Answer Key  NAMS Certification Test 98 Questions and Answer Key  NAMs Menopause Cert Exam 2025 588 Questions and Answer Key  NAMS Menopause Certification Exam 2025 292 Questions and Answer Key  NAMs Menopause Certification Exam Review 150 Questions and Answer Key pg. 2 QUESTION Which 2 nonpharmacological treatments are HIGHLY recommended by the North American Menopause Society (NAMS) to treat VMS? Answer: Cognitive behavioral therapy, clinical hypnosis QUESTION What other nonpharmacologic options are used to treat VMS? Answer: Temperature control (colder pillow) Yoga/relaxation therapy Avoid spicy foods, chocolate, caffeine Exercise Acupuncture Paced respiration (slowed down breathing) pg. 3 QUESTION What are vasomotor symptoms? Answer: Hot flushes and night sweats QUESTION What are the non-VMS of menopause? Answer: Dyspareunia, vaginal dryness, mood changes, sleep disturbances, concentration and memory issues, arthralgia QUESTION If patient has a uterus, you must give them pg. 4 Answer: estrogen + progestin combo QUESTION If patient does NOT have a uterus, you can give them Answer: estrogen alone QUESTION What are the 3 main differences in estrogen of transdermal estrogens? Answer: Lower VTE risk No impact on triglycerides Potential lower stroke risk, so lower blood clot risk pg. 5 QUESTION What are the 2 main differences in estrogen of oral estrogens? Answer: Increases triglycerides Potential for decreased libido QUESTION What is the Women's Health Initiative (WHI)? Answer: Clinical study started in 1991. Studied the use of conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA) in women with and without a uterus QUESTION What was the most important "shocking" result from the WHI? pg. 6 Answer: Estrogen + progestin combo resulted in an increased risk of breast cancer QUESTION What was the problem with how the WHI ended? ANSWER 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 QUESTION When is it considered safe to start menopause hormone therapy (MHT) in women? ANSWER Likely safe to start in patients with no contraindications who are within 10 years of menopause, and/or 60 years old according to NAMS (North American Menopause Society) pg. 7 Is tobacco use a contraindication to MHT? ANSWER Tobacco use is NOT a contraindication to hormone therapy, but transdermal therapy may be preferred What is the 1st line treatment to help with VMS of menopause after trying nonpharmacologic therapies? - ANSWER Systemic hormone therapy (HT), since it provides optimal relief of hot flushes What symptoms should be present for a woman to be on HT? - ANSWER VMS If patients have vaginal symptoms only, only use what kind of products? - ANSWER Vaginal products What are the 2 most common estrogens used in HT? - ANSWER Estradiol and Conjugated equine estrogens (CEE) What are the 2 most common progestogens used in HT? - ANSWER Medroxyprogesterone acetate (MPA) and Micronized progesterone (MP) Which hormone should be used with caution in patients with a peanut allergy? - ANSWER Micronized Progesterone (MP) pg. 8 What are all of the contraindications to MHT? - ANSWER -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? - ANSWER SSRIs, SNRIs, Clonidine, Gabapentin, Pregabalin What SSRI should be used if the patient is taking Tamoxifen for breast cancer? - ANSWER Escitalopram Which 2 SSRIs should be avoided in patients taking Tamoxifen? - ANSWER Fluoxetine, Paroxetine pg. 9 Which formulation of estrogen may be favored in patients that smoke? - ANSWER Estradiol patches Are compounded hormones recommended? - ANSWER 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)? - ANSWER Genital, sexual, and urinary symptoms What is the ideal first step for patients with urinary symptoms of GMS? - ANSWER Pelvic floor therapy What therapy is recommended for vaginal dryness/irritation/pain GMS symptoms? - ANSWER Nonpharmacological gel or a vaginal moisturizer/lubricant like Replens What is the name of the 1st line therapy vaginal moisturizer/lubricant? - ANSWER Replens What other medications are also used to treat vaginal symptoms of menopause? - ANSWER Low dose vaginal estrogen Prasterone pg. 10 Ospemifene Can also use a water-based lubricant like GoodCleanLove or Yes! Has better osmolality for the vagina Do you need a progestogen for vaginal estrogens? - ANSWER Not needed if it has a localized effect on the vagina Brand name of conjugated equine estrogen (CEE) - ANSWER Premarin Indication of Premarin - ANSWER Vulvar and vaginal atrophy with menopause Dosing of Premarin - ANSWER 0.3-1.25 mg daily Brand name of Estradiol tablet - ANSWER Estrace Estrace indication - ANSWER VMS associated with menopause, vulvar and vaginal atrophy associated with menopause, osteoporosis prevention Dosing of Estrace - ANSWER 0.5-2 mg daily What are the brand names of the Estradiol transdermal systems? - ANSWER Climara, Minivelle pg. 11 Indication of estradiol patches Climara and Minivelle - ANSWER VMS associated with menopause Dosing of Minivelle - ANSWER 0.025-0.1 mg twice a week Brand names of estradiol vaginal rings - ANSWER Estring, Femring Indication of estradiol vaginal rings - ANSWER VMS symptoms of menopause Dosing of Estring and Femring - ANSWER 12.4 mg or 24.8 mg (released as 0.05mg/day or 0.1mg/day) Indication of MPA - ANSWER Contraception, endometriosis, combined with estrogen to treat VMS of menopause Dosing of MPA - ANSWER 2.5mg/day or 5-10mg for 10-14days/month Brand name of micronized progesterone - ANSWER Prometrium What is micronized progesterone? - ANSWER Bioidentical hormone/product that has the same chemical structure of what is produced in the ovaries pg. 12 Brand name of conjugated estrogens/Bazedoxifene - ANSWER Duavee Indication of Duavee - ANSWER Postmenopausal women with a uterus; treats VMS symptoms and prevents osteoporosis MOA of Duavee - ANSWER Tissue-Selective Estrogen Complex (TSEC); CEE + SERM Duavee counseling point - ANSWER Dispense in original packaging Adverse effects of Duavee - ANSWER May increase risk of stroke and DVT Duavee could also be more useful in women that are also at risk of what disease? - ANSWER Breast cancer Indication of Replens - ANSWER Treats vulvovaginal atrophy, dyspareunia How much does Replens cost? - ANSWER $20 Brand name of Prasterone - ANSWER Intrarosa pg. 13 Indication of Prasterone - ANSWER Treats vaginal symptoms of GMS; treats dyspareunia MOA of Prasterone - ANSWER Is made up of DHEA, which is metabolized to Estradiol and androgens; restores vaginal tissue Dosing of Prasterone - ANSWER 1 vaginal insert contains 6.5mg of Prasterone Contraindications of Prasterone - ANSWER Undiagnosed genital bleeding, suspected or known breast cancer Indication of Venlafaxine - ANSWER VMS of menopause MOA of Venlafaxine - ANSWER Inhibits CNS serotonin and NE reuptake Side effects of Venlafaxine - ANSWER GI upset, sleep disturbances (insomnia or fatigue), blood pressure may increase Counseling points with Venlafaxine - ANSWER Recommend to take in the morning with breakfast. Blood pressure increase usually occurs on higher doses pg. 14 Brand name of Paroxetine mesylate - ANSWER Brisdelle Indication of Brisdelle - ANSWER Moderate-severe VMS 7-8 times a day Dosing of Paroxetine mesylate - ANSWER 7.5 mg daily at bedtime Side effects of Brisdelle - ANSWER N/V, headache, fatigue Brisdelle should be avoided in which patients? - ANSWER Patients on Tamoxifen Indication of Gabapentin - ANSWER VMS of menopause MOA of Gabapentin - ANSWER unknown Dosing of Gabapentin - ANSWER 900mg/day in divided doses is the target dose Side effects of Gabapentin - ANSWER Somnolence, dizziness Brand name of Ospemifene - ANSWER Osphena pg. 15 Indication of Ospemifene - ANSWER Treats vaginal symptoms of GMS such as moderate-severe dyspareunia MOA of Ospemifene - ANSWER SERM Dosing of Ospemifene - ANSWER 60 mg once daily orally with food Side effects of Ospemifene - ANSWER Hot flush, vaginal discharge, muscle spasms, genital discharge, hyperhidrosis Drug interactions with Ospemifene - ANSWER Rifampin, Fluconazole, estrogen agonist/antagonist Contraindications of Ospemifene - ANSWER Undiagnosed genital bleeding, history of VTE, arterial thrombotic disease, estrogen-dependent neoplasia pg. 16  NAMS Menopause Certification Exam Practice 102 Questions and Answer Key  NAMs Menopause Certification Study Guide 257 Questions and Answer Key  NAMS Certification Exam 121 Questions and Answer Key  2025 - NAMS Menopause Certification Exam Study Set 385 Questions and Answer Key  Menopause Society Exam: Key Quiz 120 Questions and Answer Key  NAMS Certification Test 98 Questions and Answer Key  NAMs Menopause Cert Exam 2025 588 Questions and Answer Key  NAMS Menopause Certification Exam 2025 292 Questions and Answer Key  NAMs Menopause Certification Exam Review 150 Questions and Answer Key Cognitive behavioral therapy, clinical hypnosis Which 2 nonpharmacologic treatments are HIGHLY recommended by the North American Menopause Society (NAMS) to treat VMS? Temperature control (colder pillow) Yoga/relaxation therapy Avoid spicy foods, chocolate, caffeine Exercise pg. 17 Acupuncture Paced respiration (slowed down breathing) What other nonpharmacologic options are used to treat VMS? Hot flushes and night sweats What are vasomotor symptoms? Dyspareunia, vaginal dryness, mood changes, sleep disturbances, concentration and memory issues, arthralgia What are the non-VMS of menopause? estrogen + progestin combo If patient has a uterus, you must give them estrogen alone If patient does NOT have a uterus, you can give them Lower VTE risk No impact on triglycerides Potential lower stroke risk, so lower blood clot risk What are the 3 main differences in estrogen of transdermal estrogens? Increases triglycerides Potential for decreased libido What are the 2 main differences in estrogen of oral estrogens? 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 is the Women's Health Initiative (WHI)? Estrogen + progestin combo resulted in an increased risk of breast cancer pg. 18 What was the most important "shocking" result from the WHI? 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 What was the problem with how the WHI ended? Likely safe to start in patients with no contraindications who are within 10 years of menopause, and/or 60 years old according to NAMS (North American Menopause Society) When is it considered safe to start menopause hormone therapy (MHT) in women? Tobacco use is NOT a contraindication to hormone therapy, but transdermal therapy may be preferred Is tobacco use a contraindication to MHT? Systemic hormone therapy (HT), since it provides optimal relief of hot flushes What is the 1st line treatment to help with VMS of menopause after trying nonpharmacologic therapies? VMS What symptoms should be present for a woman to be on HT? Vaginal products If patients have vaginal symptoms only, only use what kind of products? Estradiol and Conjugated equine estrogens (CEE) What are the 2 most common estrogens used in HT? Medroxyprogesterone acetate (MPA) and Micronized progesterone (MP) What are the 2 most common progestogens used in HT? pg. 19 Micronized Progesterone (MP) Which hormone should be used with caution in patients with a peanut allergy? -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 all of the contraindications to MHT? SSRIs, SNRIs, Clonidine, Gabapentin, Pregabalin What are the nonhormonal medications that can be used to treat VMS? Escitalopram What SSRI should be used if the patient is taking Tamoxifen for breast cancer? Fluoxetine, Paroxetine Which 2 SSRIs should be avoided in patients taking Tamoxifen? Estradiol patches Which formulation of estrogen may be favored in patients that smoke? Compounded hormones/plant-derived hormones are not recommended by the guidelines. Lack of FDA oversight, variability in dosing and absorption, conventional hormone therapy preferred Are compounded hormones recommended? pg. 20 Genital, sexual, and urinary symptoms What are Genitourinary Syndromes of Menopause (GSM)? Pelvic floor therapy What is the ideal first step for patients with urinary symptoms of GMS? Nonpharmacological gel or a vaginal moisturizer/lubricant like Replens What therapy is recommended for vaginal dryness/irritation/pain GMS symptoms? Replens What is the name of the 1st line therapy vaginal moisturizer/lubricant? Low dose vaginal estrogen Prasterone Ospemifene Can also use a water-based lubricant like GoodCleanLove or Yes! Has better osmolality for the vagina What other medications are also used to treat vaginal symptoms of menopause? Not needed if it has a localized effect on the vagina Do you need a progestogen for vaginal estrogens? Premarin Brand name of conjugated equine estrogen (CEE) Vulvar and vaginal atrophy with menopause Indication of Premarin 0.3-1.25 mg daily Dosing of Premarin pg. 21 Estrace Brand name of Estradiol tablet VMS associated with menopause, vulvar and vaginal atrophy associated with menopause, osteoporosis prevention Estrace indication 0.5-2 mg daily Dosing of Estrace Climara, Minivelle What are the brand names of the Estradiol transdermal systems? VMS associated with menopause Indication of estradiol patches Climara and Minivelle 0.025-0.1 mg twice a week Dosing of Minivelle Estring, Femring Brand names of estradiol vaginal rings VMS symptoms of menopause Indication of estradiol vaginal rings 12.4 mg or 24.8 mg (released as 0.05mg/day or 0.1mg/day) Dosing of Estring and Femring Contraception, endometriosis, combined with estrogen to treat VMS of menopause Indication of MPA pg. 22 2.5mg/day or 5-10mg for 10-14days/month Dosing of MPA Prometrium Brand name of micronized progesterone Bioidentical hormone/product that has the same chemical structure of what is produced in the ovaries What is micronized progesterone? Duavee Brand name of conjugated estrogens/Bazedoxifene Postmenopausal women with a uterus; treats VMS symptoms and prevents osteoporosis Indication of Duavee Tissue-Selective Estrogen Complex (TSEC); CEE + SERM MOA of Duavee Dispense in original packaging Duavee counseling point May increase risk of stroke and DVT Adverse effects of Duavee Breast cancer Duavee could also be more useful in women that are also at risk of what disease? Treats vulvovaginal atrophy, dyspareunia Indication of Replens pg. 23 $20 How much does Replens cost? Intrarosa Brand name of Prasterone Treats vaginal symptoms of GMS; treats dyspareunia Indication of Prasterone Is made up of DHEA, which is metabolized to Estradiol and androgens; restores vaginal tissue MOA of Prasterone 1 vaginal insert contains 6.5mg of Prasterone Dosing of Prasterone Undiagnosed genital bleeding, suspected or known breast cancer Contraindications of Prasterone VMS of menopause Indication of Venlafaxine Inhibits CNS serotonin and NE reuptake MOA of Venlafaxine GI upset, sleep disturbances (insomnia or fatigue), blood pressure may increase Side effects of Venlafaxine Recommend to take in the morning with breakfast. Blood pressure increase usually occurs on higher doses Counseling points with Venlafaxine pg. 24 Brisdelle Brand name of Paroxetine mesylate Moderate-severe VMS 7-8 times a day Indication of Brisdelle 7.5 mg daily at bedtime Dosing of Paroxetine mesylate N/V, headache, fatigue Side effects of Brisdelle Patients on Tamoxifen Brisdelle should be avoided in which patients? VMS of menopause Indication of Gabapentin unknown MOA of Gabapentin 900mg/day in divided doses is the target dose Dosing of Gabapentin Somnolence, dizziness Side effects of Gabapentin Osphena Brand name of Ospemifene Treats vaginal symptoms of GMS such as moderate-severe dyspareunia pg. 25 Indication of Ospemifene SERM MOA of Ospemifene 60 mg once daily orally with food Dosing of Ospemifene Hot flush, vaginal discharge, muscle spasms, genital discharge, hyperhidrosis Side effects of Ospemifene Rifampin, Fluconazole, estrogen agonist/antagonist Drug interactions with Ospemifene Undiagnosed genital bleeding, history of VTE, arterial thrombotic disease, estrogendependent neoplasia Contraindications of Ospemifene The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of menopause. Climacteric phase LMP before age 45 Early menopause LMP after age 54 Late menopause Menopause that occurs before age 40 Primary ovarian insufficiency Persistent difference of 7 days or more in the length of consecutive cycles. pg. 26 Early menopause transition (stage -2) 60 or more consecutive days of amenorrhea Late menopause transition (stage -1) Explains why some perimenopausal women have elevated estrogen level sometimes...In the early menopause transition, elevated FSH levels are adequate to recruit a second follicle which results in a follicular phase-like rise in estradiol secretion superimposed on the mid-to-late luteal phase of the ongoing ovulatory cycle. Luteal out of phase event (LOOP) Obese women are more likely to have anovulatory cycles with high estradiol levels. They are also more likely to have lower premenopause yet higher postmenopause estradiol levels compared with women of normal weight. (why they are at higher risk of endometrial cancer) Obese women and estradiol levels during menopause These ethnic groups have lower estradiol levels then white, black and hispanic women. Chinese and Japanese women late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary symptoms. stage +2 early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate. Stages +1a, +1b, +1c Endocrine labs after menopause Elevated FSH, LH pg. 27 These hormones work during reproductive years to not deplete follicle pool too quickly. AMH, inhibin B Menstrual cycle variable, persistent 7 day difference between difference in length of consecutive cycles. Phases during menopause transition and PMS symptoms many pitfalls, variable depending on the day of the cycle you draw the lab, normal or low FSH is not helpful. How to respond if a patient requests FSH lab? AMH The potentially superior marker of menopause, a lab. Adrenal androgens: precursor hromones produced by the adrenal gland that are enzymatically converted to active androgens or estrogens in peripheral tissues. DHEA (dehydroepiandrosterone) Vagina, vulva, urethra, trigone of the bladder Location of estrogen receptors maintain blood flow, the collagen, and HA within the epithelial surfaces. Supports microbiome which supports acidity of vagina and protects tissue from pathogens. Effects of estrogen on tissue Thinning, loss of elasticity, loss or absence or rugae. Vaginal changes with menopause vagina narrows, urethra moves closer to the introitus. Vagina and urethra in menopause pg. 28 Vaginal estrogen and urinary incontinence: what type does it help with? Stress urinary incontinence Minoxidil, spironolactone, finasteride, estrogen therapy Treatment for FPHL -3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low. -3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low. Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level. When it is appropriate to check an FSH during the cycle if you check it? and why? produced by granulosa cells used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low ovarian reserve. not recommended as a screening tool to predict fertility. Peaks at around 25 years old. So before age 25, this test is not helpful. It is influenced by exogenous hormones. Lower in hormonal contraception users, but increases after d/cing. AMH produced by... used to test... pg. 29 Is it a screening tool for fertility? When does it peak? Antral follicle count Number of follicles that are detectable with ultrasound. They are sensitive to FSH and considered to represent the availability pool of follicles. AFC 25 or higher Late menopause transition (-1) FSH level on random draw Higher Black women have higher or lower FSH levels? lower Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic women? SHBG decreases Testosterone/SHBG ratio increases by 80%. Menopause transition-changes in SHBG and testosterone? ratio? The free androgen index Testosterone/SHGB ratio is called what? +1b (generally last 2 years) What stage are VMS more likely? Estrone-via aromatization. What hormone is generally higher in obese women? pg. 30 testosterone and androstenedione The postmenopausal ovary continues to produce what two hormones? testosterone. 40-50% lower than in women w/ intact ovaries. Surgical menopause causes women to have lower levels of what hormone? inhibin and AMH decrease therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished follicle pool. Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B and AMH? Luteal-more PMS symptoms, more frequent menstrual periods. In the menopause transition, women spend more time in what phase? It is felt that the HPO axis may become less sensitive to estrogen, so even with good follicle growth and estradiol secretion, LH surges can fail which can lead to more cycle irregularity. HPO axis theory and the menopause transition progesterone In the first year after the FMP, there is no production of what hormone? zona reticularis What region of the adrenal gland secretes the androgens? DHEA, DHEAS, Androstenedione. what are considered the 'adrenal androgens'? pg. 31 Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by the anterior pituitary. Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors. Anterior pituitary. The posterior only secretes vasopressin and oxytosin. What part of the pituitary gland secretes adrenocorticotropic hormone? Most serum cortisol circulates bound to cortisol binding globulin. Oral estrogen increases the cortisol binding globulin, which increases total cortisol concentration. Oral tamoxifen acts similarly. Transdermal does not increase it, so it has a minimal effect on serum cortisol concentration. Cortisol and HRT No, cortisol levels have NOT been associated with more severe VMS. Do cortisol levels associate with VMS severity? vaginal pain and dyspareunia Local DHEA has been proven to help with what? Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months. AND elevated FSH over 25 on two occasions at least 4 weeks apart. pg. 32 How to DX POI? prolactin FSH estradiol TSH pregnancy test Anyone 40years old who misses 3+ consecutive cycles gets these labs 100 microgram estradiol patch 1.25 mg CEE 2mg oral estradiol If intact uterus-progesterone for 12 days of the month. Physiologic is better than continuous hormonal contractption, but if menorrhagia-IUD plus estrogen patch, or if really not wanting to risk pregnancy, continuous HRT can be used. treatment of POI FPHL is gradual, telogen effluvium is sudden and usually precipitated by a life stressor, chronic illness, beta blockers or anticoagulants-usually more patchy hair loss. Hair loss. Difference between FPHL and telogen effluvium? thinning at the crown of the head and widening of the hair part FPHL pattern MINOXIDIL spironolactone finasteride pg. 33 Treating FPHL Japanese What ethnicity has the least likely chance of having bad hot flashes? black more frequent, longer duration. What ethnicity is the most likely to have bad hot flashes? 10 years, early menopause transition women have them the longest. Median length of hot flashes lower ovarian estradiol thermoregulation zone is narrowed neurokinins-regulate GnRH secretion. KNDy new meds serotonin cortisol and HPI axis dysregulation endothelial dysfunction. Theories about etiology of hot flashes (6) low grade is not precancerous high grade is precancerous-GYN ONC differentiated-wide local excision-high risk of invasive carcinoma. VIN low grade-what to do high grade-what to do differentiated VIN-what to do squamous cell carcinoma most common type of vulvar cancer pg. 34 paget's disease will not improve on steroids screen for co-existing breast, GI or GU cancer. They are present 20-30% of the time. Vulvar disorder commonly misdiagnosed as eczema or dermatitis? 100mL Normal PVR will NOT help with stress incontinence. systemic and vaginal estrogen will not help with this type of urinary incontinence? the vaginal rings FEMRING IS THE HIGHEST Which topical vaginal estrogen has the highest dose? BV Most common cause of vulvovaginitis? desquamative inflammatory vaginitis. treat different with clindamycin or hydrocortisone+ET post menopause burning and diffuse yellow/brown discharge and dyspareunia that does not respond to local ET? circulating androgens What hormones are associated with sexual desire in women? circulating androgen levels pg. 35 Women who have had a BSO experience an abrupt and persistent decline in what hormone? female sexual interest/arousal disorder HSDD and FSAD were combined into a single dysrunction called flibanserin and bremelanotide HSDD treatments L-arginine, topical alprostadil, wellbutrin, oxytosin. phosphodiesterase inhibitors-lacking in efficacy Eros therapy device $300- vaccum-like the penis p