NAMS Menopause Certification Exam Questions
and Answers (Graded A+) | 2025/2026
QUESTION 1:
Which of the following best describes the primary physiological change responsible for the
onset of menopause?
A. Increased hypothalamic sensitivity to estrogen
B. Accelerated follicular atresia leading to estrogen decline
C. Heightened adrenal androgen production
D. Hyperactivity of the pituitary gland
CORRECT ANSWER: B
RATIONALE: Menopause occurs due to depletion of ovarian follicles leading to decreased
estrogen production. Follicular atresia reduces estrogen output, causing increased FSH/LH levels.
The other options do not explain this process accurately.
QUESTION 2:
True or False: The average age of natural menopause in North American women is
approximately 51 years.
CORRECT ANSWER: True
RATIONALE: Extensive epidemiological data from NAMS indicate the median age for
menopause is 51 years, though it typically ranges from 45–55 years.
QUESTION 3:
Which hormone primarily drives the vasomotor symptoms experienced during menopause?
A. Progesterone
B. Estrogen
C. Follicle-stimulating hormone
D. Cortisol
CORRECT ANSWER: B
RATIONALE: Estrogen deficiency affects hypothalamic thermoregulation, causing hot flashes
and night sweats. Other hormones play secondary roles.
QUESTION 4:
A 52-year-old woman presents with night sweats and irregular periods. She is most likely in
,which menopausal stage?
A. Premenopause
B. Early perimenopause
C. Late perimenopause
D. Postmenopause
CORRECT ANSWER: C
RATIONALE: Late perimenopause involves frequent vasomotor symptoms and amenorrhea
lasting more than 60 days. The pattern indicates transition nearing menopause.
QUESTION 5:
Which of the following nonhormonal therapies has the strongest evidence base for reducing
vasomotor symptoms?
A. Vitamin E
B. Black cohosh
C. SSRIs/SNRIs
D. Wild yam extract
CORRECT ANSWER: C
RATIONALE: SSRIs and SNRIs, such as paroxetine or venlafaxine, have significant randomized
trial support for improving hot flashes. Herbal options show inconsistent results.
QUESTION 6:
Short Answer:
List two contraindications to systemic hormone therapy in menopausal women.
CORRECT ANSWER: 1. Active breast cancer; 2. Undiagnosed vaginal bleeding
RATIONALE: Systemic estrogen therapy can worsen estrogen-sensitive cancers and masks
serious underlying pathologies when bleeding source is unidentified.
QUESTION 7:
Which estrogen formulation has the lowest risk for venous thromboembolism (VTE)?
A. Oral conjugated estrogen
B. Transdermal estradiol
C. Estrogen vaginal cream
D. Esterified estrogen tablets
, CORRECT ANSWER: B
RATIONALE: Transdermal estrogen avoids first-pass hepatic metabolism, reducing the
procoagulant effect seen with oral preparations.
QUESTION 8:
True or False: Local vaginal estrogen therapy requires concurrent progestogen in women with an
intact uterus.
CORRECT ANSWER: False
RATIONALE: Low-dose vaginal estrogen has minimal systemic absorption, so endometrial
stimulation risk is negligible.
QUESTION 9:
Which of the following is a common side effect of systemic estrogen therapy?
A. Thinning of skin
B. Nausea and breast tenderness
C. Alopecia
D. Insomnia
CORRECT ANSWER: B
RATIONALE: Estrogen stimulates breast tissue and can cause transient tenderness; nausea
results from first-pass metabolism.
QUESTION 10:
A patient on estrogen therapy complains of breast tenderness. Which adjustment is most
appropriate?
A. Increase estrogen dose
B. Add testosterone
C. Lower estrogen dose
D. Stop progestogen
CORRECT ANSWER: C
RATIONALE: Reducing estrogen may alleviate receptor overstimulation in breast tissue.
and Answers (Graded A+) | 2025/2026
QUESTION 1:
Which of the following best describes the primary physiological change responsible for the
onset of menopause?
A. Increased hypothalamic sensitivity to estrogen
B. Accelerated follicular atresia leading to estrogen decline
C. Heightened adrenal androgen production
D. Hyperactivity of the pituitary gland
CORRECT ANSWER: B
RATIONALE: Menopause occurs due to depletion of ovarian follicles leading to decreased
estrogen production. Follicular atresia reduces estrogen output, causing increased FSH/LH levels.
The other options do not explain this process accurately.
QUESTION 2:
True or False: The average age of natural menopause in North American women is
approximately 51 years.
CORRECT ANSWER: True
RATIONALE: Extensive epidemiological data from NAMS indicate the median age for
menopause is 51 years, though it typically ranges from 45–55 years.
QUESTION 3:
Which hormone primarily drives the vasomotor symptoms experienced during menopause?
A. Progesterone
B. Estrogen
C. Follicle-stimulating hormone
D. Cortisol
CORRECT ANSWER: B
RATIONALE: Estrogen deficiency affects hypothalamic thermoregulation, causing hot flashes
and night sweats. Other hormones play secondary roles.
QUESTION 4:
A 52-year-old woman presents with night sweats and irregular periods. She is most likely in
,which menopausal stage?
A. Premenopause
B. Early perimenopause
C. Late perimenopause
D. Postmenopause
CORRECT ANSWER: C
RATIONALE: Late perimenopause involves frequent vasomotor symptoms and amenorrhea
lasting more than 60 days. The pattern indicates transition nearing menopause.
QUESTION 5:
Which of the following nonhormonal therapies has the strongest evidence base for reducing
vasomotor symptoms?
A. Vitamin E
B. Black cohosh
C. SSRIs/SNRIs
D. Wild yam extract
CORRECT ANSWER: C
RATIONALE: SSRIs and SNRIs, such as paroxetine or venlafaxine, have significant randomized
trial support for improving hot flashes. Herbal options show inconsistent results.
QUESTION 6:
Short Answer:
List two contraindications to systemic hormone therapy in menopausal women.
CORRECT ANSWER: 1. Active breast cancer; 2. Undiagnosed vaginal bleeding
RATIONALE: Systemic estrogen therapy can worsen estrogen-sensitive cancers and masks
serious underlying pathologies when bleeding source is unidentified.
QUESTION 7:
Which estrogen formulation has the lowest risk for venous thromboembolism (VTE)?
A. Oral conjugated estrogen
B. Transdermal estradiol
C. Estrogen vaginal cream
D. Esterified estrogen tablets
, CORRECT ANSWER: B
RATIONALE: Transdermal estrogen avoids first-pass hepatic metabolism, reducing the
procoagulant effect seen with oral preparations.
QUESTION 8:
True or False: Local vaginal estrogen therapy requires concurrent progestogen in women with an
intact uterus.
CORRECT ANSWER: False
RATIONALE: Low-dose vaginal estrogen has minimal systemic absorption, so endometrial
stimulation risk is negligible.
QUESTION 9:
Which of the following is a common side effect of systemic estrogen therapy?
A. Thinning of skin
B. Nausea and breast tenderness
C. Alopecia
D. Insomnia
CORRECT ANSWER: B
RATIONALE: Estrogen stimulates breast tissue and can cause transient tenderness; nausea
results from first-pass metabolism.
QUESTION 10:
A patient on estrogen therapy complains of breast tenderness. Which adjustment is most
appropriate?
A. Increase estrogen dose
B. Add testosterone
C. Lower estrogen dose
D. Stop progestogen
CORRECT ANSWER: C
RATIONALE: Reducing estrogen may alleviate receptor overstimulation in breast tissue.
