NAMS MENOPAUSE CERTIFICATION:
ACTUAL REAL EXAM TEST BANK, (LATEST
2026/2027 UPDATE), WITH
CORRECT/ACCURATE ANSWERS
NORTH AMERICAN MENOPAUSE SOCIETY
(NAMS) CERTIFICATION
Multiple-choice format
Correct answer clearly identified
Deep rationales (3–5 sentences each)
Rationales numbered sequentially (1–40)
QUESTIONS 1–40
Question 1
A postmenopausal woman presents with persistent vaginal burning, dyspareunia, and
a diffuse yellow-brown vaginal discharge that does not improve with local estrogen
therapy. Which diagnosis is most likely?
A. Genitourinary syndrome of menopause (GSM)
B. Bacterial vaginosis
C. Desquamative inflammatory vaginitis
D. Vulvovaginal candidiasis
Correct Answer: C
Rationale (1):
Desquamative inflammatory vaginitis (DIV) is characterized by purulent discharge,
burning, dyspareunia, and vaginal inflammation that does not respond to estrogen
alone. Unlike GSM, DIV is inflammatory and often requires treatment with intravaginal
clindamycin or hydrocortisone. The presence of yellow or brown discharge and lack of
,estrogen response helps distinguish DIV from atrophic vaginitis. Early recognition is
critical to relieve symptoms and prevent chronic inflammation.
Question 2
Which hormone group plays the most significant role in sexual desire in women?
A. Estrogens
B. Progesterone
C. Circulating androgens
D. Prolactin
Correct Answer: C
Rationale (2):
Circulating androgens, including testosterone, are strongly associated with sexual
desire and motivation in women. Although estrogen contributes to vaginal health and
comfort, libido is more closely tied to androgen activity. Androgen levels decline with
age and particularly after oophorectomy, contributing to hypoactive sexual desire
disorder. This understanding informs treatment approaches for sexual dysfunction.
Question 3
Women who undergo bilateral salpingo-oophorectomy (BSO) experience an abrupt and
sustained decline in which hormone?
A. Estradiol
B. Progesterone
C. Circulating androgen levels
D. Cortisol
Correct Answer: C
,Rationale (3):
The ovaries are a major source of circulating androgens even after menopause.
Removal of both ovaries results in an immediate and persistent decline in androgen
levels. This decline may contribute to reduced libido, fatigue, and decreased well-
being. Estrogen levels also drop, but androgen loss is particularly abrupt and long-
lasting after BSO.
Question 4
Which term now combines hypoactive sexual desire disorder (HSDD) and female
sexual arousal disorder (FSAD)?
A. Female orgasmic disorder
B. Female sexual interest/arousal disorder
C. Persistent genital arousal disorder
D. Vulvovaginal atrophy
Correct Answer: B
Rationale (4):
The DSM-5 merged HSDD and FSAD into female sexual interest/arousal disorder to
reflect overlapping symptoms and shared pathophysiology. This change acknowledges
that desire and arousal are not easily separated in many women. The combined
diagnosis improves diagnostic accuracy and guides more holistic treatment
approaches. It also reflects evolving understanding of female sexual response.
Question 5
Which medications are FDA-approved treatments for hypoactive sexual desire disorder
in premenopausal women?
A. Testosterone and sildenafil
B. Flibanserin and bremelanotide
, C. Estrogen and progesterone
D. Dopamine agonists
Correct Answer: B
Rationale (5):
Flibanserin and bremelanotide are FDA-approved treatments for HSDD in
premenopausal women. Flibanserin modulates serotonin, dopamine, and
norepinephrine pathways, while bremelanotide activates melanocortin receptors. Both
target central mechanisms of sexual desire rather than peripheral genital response.
Their use requires patient counseling regarding side effects and expectations.
Question 6
Which of the following treatments has shown limited efficacy for female genital
arousal disorder (FGAD)?
A. L-arginine
B. Phosphodiesterase inhibitors
C. Topical alprostadil
D. Vacuum-based Eros therapy
Correct Answer: B
Rationale (6):
Phosphodiesterase inhibitors, while effective for erectile dysfunction in men, have
shown inconsistent and limited benefit in women with FGAD. Female sexual arousal
involves complex neurovascular and psychological components not adequately
addressed by PDE inhibitors alone. Other therapies such as topical agents and devices
may provide localized benefit. Treatment often requires a multimodal approach.
Question 7
ACTUAL REAL EXAM TEST BANK, (LATEST
2026/2027 UPDATE), WITH
CORRECT/ACCURATE ANSWERS
NORTH AMERICAN MENOPAUSE SOCIETY
(NAMS) CERTIFICATION
Multiple-choice format
Correct answer clearly identified
Deep rationales (3–5 sentences each)
Rationales numbered sequentially (1–40)
QUESTIONS 1–40
Question 1
A postmenopausal woman presents with persistent vaginal burning, dyspareunia, and
a diffuse yellow-brown vaginal discharge that does not improve with local estrogen
therapy. Which diagnosis is most likely?
A. Genitourinary syndrome of menopause (GSM)
B. Bacterial vaginosis
C. Desquamative inflammatory vaginitis
D. Vulvovaginal candidiasis
Correct Answer: C
Rationale (1):
Desquamative inflammatory vaginitis (DIV) is characterized by purulent discharge,
burning, dyspareunia, and vaginal inflammation that does not respond to estrogen
alone. Unlike GSM, DIV is inflammatory and often requires treatment with intravaginal
clindamycin or hydrocortisone. The presence of yellow or brown discharge and lack of
,estrogen response helps distinguish DIV from atrophic vaginitis. Early recognition is
critical to relieve symptoms and prevent chronic inflammation.
Question 2
Which hormone group plays the most significant role in sexual desire in women?
A. Estrogens
B. Progesterone
C. Circulating androgens
D. Prolactin
Correct Answer: C
Rationale (2):
Circulating androgens, including testosterone, are strongly associated with sexual
desire and motivation in women. Although estrogen contributes to vaginal health and
comfort, libido is more closely tied to androgen activity. Androgen levels decline with
age and particularly after oophorectomy, contributing to hypoactive sexual desire
disorder. This understanding informs treatment approaches for sexual dysfunction.
Question 3
Women who undergo bilateral salpingo-oophorectomy (BSO) experience an abrupt and
sustained decline in which hormone?
A. Estradiol
B. Progesterone
C. Circulating androgen levels
D. Cortisol
Correct Answer: C
,Rationale (3):
The ovaries are a major source of circulating androgens even after menopause.
Removal of both ovaries results in an immediate and persistent decline in androgen
levels. This decline may contribute to reduced libido, fatigue, and decreased well-
being. Estrogen levels also drop, but androgen loss is particularly abrupt and long-
lasting after BSO.
Question 4
Which term now combines hypoactive sexual desire disorder (HSDD) and female
sexual arousal disorder (FSAD)?
A. Female orgasmic disorder
B. Female sexual interest/arousal disorder
C. Persistent genital arousal disorder
D. Vulvovaginal atrophy
Correct Answer: B
Rationale (4):
The DSM-5 merged HSDD and FSAD into female sexual interest/arousal disorder to
reflect overlapping symptoms and shared pathophysiology. This change acknowledges
that desire and arousal are not easily separated in many women. The combined
diagnosis improves diagnostic accuracy and guides more holistic treatment
approaches. It also reflects evolving understanding of female sexual response.
Question 5
Which medications are FDA-approved treatments for hypoactive sexual desire disorder
in premenopausal women?
A. Testosterone and sildenafil
B. Flibanserin and bremelanotide
, C. Estrogen and progesterone
D. Dopamine agonists
Correct Answer: B
Rationale (5):
Flibanserin and bremelanotide are FDA-approved treatments for HSDD in
premenopausal women. Flibanserin modulates serotonin, dopamine, and
norepinephrine pathways, while bremelanotide activates melanocortin receptors. Both
target central mechanisms of sexual desire rather than peripheral genital response.
Their use requires patient counseling regarding side effects and expectations.
Question 6
Which of the following treatments has shown limited efficacy for female genital
arousal disorder (FGAD)?
A. L-arginine
B. Phosphodiesterase inhibitors
C. Topical alprostadil
D. Vacuum-based Eros therapy
Correct Answer: B
Rationale (6):
Phosphodiesterase inhibitors, while effective for erectile dysfunction in men, have
shown inconsistent and limited benefit in women with FGAD. Female sexual arousal
involves complex neurovascular and psychological components not adequately
addressed by PDE inhibitors alone. Other therapies such as topical agents and devices
may provide localized benefit. Treatment often requires a multimodal approach.
Question 7
