NAMS Menopause Certification Exam (MSCP) Practice Questions and
Answers (Graded A+) | 2025/2026
These 100 original multiple-choice practice questions are based on the 2025/2026 North
American Menopause Society (NAMS) Menopause Society Certified Practitioner (MSCP,
formerly NCMP) competency examination guidelines, as outlined in the 2025 Candidate
Handbook. The questions align with the five major domains: Physiology/Pathophysiology of the
Menopause Transition (19%), Symptoms and Concerns (20%), Health Disorders in Midlife (21%),
Treatment Options for Common Menopause Symptoms (16%), and Preventive Care and
Counseling (19%). The exam consists of 100 multiple-choice questions with three options (A–C),
to be completed in 2 hours, testing recall, application, and analysis levels, with a passing scaled
score of at least 75 (out of 99). Questions focus on evidence-based menopause care, including
hormone therapy, symptom management, and preventive strategies.
1. A 48-year-old woman experiences irregular periods and hot flashes. According to the
Stages of Reproductive Aging Workshop (STRAW), this is most likely:
A. Late menopause
B. Menopause transition
C. Postmenopause
Correct Answer: B
Rationale: The menopause transition (STRAW stages -2 to -1) involves cycle irregularity
and vasomotor symptoms; late menopause (A) is not a STRAW term, and
postmenopause (C) begins after 12 months of amenorrhea (Domain 1:
Physiology/Pathophysiology, 4%).
2. Which hormonal change primarily drives vasomotor symptoms during the menopause
transition?
A. Stable estrogen levels
B. Fluctuating estradiol
C. Increased progesterone
Correct Answer: B
Rationale: Fluctuating estradiol levels trigger vasomotor symptoms; stable estrogen (A)
does not occur in transition, and progesterone (C) decreases (Domain 1:
Physiology/Pathophysiology, 5%).
3. A 35-year-old woman with primary ovarian insufficiency (POI) should be counseled on:
A. No need for hormone therapy
B. Hormone therapy until age 50 for bone and cardiovascular protection
C. Immediate discontinuation of contraception
, Correct Answer: B
Rationale: Hormone therapy is recommended for POI to mitigate risks of early estrogen
loss; no therapy (A) increases risks, and contraception (C) depends on fertility goals
(Domain 1: Physiology/Pathophysiology, 5%).
4. The mean age of natural menopause in the United States is:
A. 45 years
B. 51 years
C. 55 years
Correct Answer: B
Rationale: Demographics indicate a mean age of 51; 45 (A) is early, 55 (C) is late (Domain
1: Physiology/Pathophysiology, 5%).
5. In surgical menopause after bilateral oophorectomy, the key clinical consequence is:
A. Gradual symptom onset
B. Abrupt estrogen loss leading to severe vasomotor symptoms
C. No change in bone density
Correct Answer: B
Rationale: Abrupt loss causes immediate symptoms; gradual (A) is natural menopause,
bone density (C) decreases (Domain 1: Physiology/Pathophysiology, 5%).
6. A 52-year-old woman reports weight gain around her abdomen. This is associated with:
A. Increased estrogen
B. Central adiposity due to menopause-related metabolic changes
C. Decreased cortisol
Correct Answer: B
Rationale: Menopause promotes central fat distribution; estrogen (A) decreases, cortisol
(C) may rise but not primary (Domain 2: Symptoms and Concerns, 2%).
7. Which treatment is highly recommended by NAMS for vasomotor symptoms (VMS)?
A. Herbal supplements only
B. Cognitive behavioral therapy (CBT)
C. High-dose progesterone
Correct Answer: B
Rationale: CBT is evidence-based for VMS; herbs (A) have limited efficacy, progesterone
(C) is not first-line (Domain 2: Symptoms and Concerns, 2%).
8. Genitourinary syndrome of menopause (GSM) includes:
A. Only urinary incontinence
B. Vaginal dryness, dyspareunia, and urinary symptoms
, C. Hot flashes
Correct Answer: B
Rationale: GSM encompasses vulvovaginal and urinary changes; incontinence (A) is part
but not all, hot flashes (C) are VMS (Domain 2: Symptoms and Concerns, 2%).
9. A 55-year-old woman has sleep disturbances. The most likely menopause-related cause
is:
A. Daytime napping
B. VMS disrupting sleep
C. Increased caffeine intake
Correct Answer: B
Rationale: VMS often cause awakenings; napping (A) or caffeine (C) are behavioral
(Domain 2: Symptoms and Concerns, 2%).
10. Which is a common sexual health concern in menopause?
A. Increased libido
B. Decreased lubrication and arousal
C. No changes
Correct Answer: B
Rationale: Estrogen decline affects lubrication; increased libido (A) uncommon, no
changes (C) inaccurate (Domain 2: Symptoms and Concerns, 2%).
11. Abnormal uterine bleeding in perimenopause requires evaluation for:
A. Always benign causes
B. Endometrial hyperplasia or cancer
C. No workup needed
Correct Answer: B
Rationale: PALM-COEIN classification guides, cancer risk increases; benign (A) not
always, no workup (C) risky (Domain 2: Symptoms and Concerns, 2%).
12. Migraine headaches in menopause may be influenced by:
A. Stable hormones
B. Fluctuating estrogen
C. Increased progesterone
Correct Answer: B
Rationale: Estrogen fluctuations trigger migraines; stable (A) less likely, progesterone (C)
not primary (Domain 3: Health Disorders in Midlife, 2%).
13. A 60-year-old woman has hypertension. Menopause-related risk is:
A. Decreased blood pressure
Answers (Graded A+) | 2025/2026
These 100 original multiple-choice practice questions are based on the 2025/2026 North
American Menopause Society (NAMS) Menopause Society Certified Practitioner (MSCP,
formerly NCMP) competency examination guidelines, as outlined in the 2025 Candidate
Handbook. The questions align with the five major domains: Physiology/Pathophysiology of the
Menopause Transition (19%), Symptoms and Concerns (20%), Health Disorders in Midlife (21%),
Treatment Options for Common Menopause Symptoms (16%), and Preventive Care and
Counseling (19%). The exam consists of 100 multiple-choice questions with three options (A–C),
to be completed in 2 hours, testing recall, application, and analysis levels, with a passing scaled
score of at least 75 (out of 99). Questions focus on evidence-based menopause care, including
hormone therapy, symptom management, and preventive strategies.
1. A 48-year-old woman experiences irregular periods and hot flashes. According to the
Stages of Reproductive Aging Workshop (STRAW), this is most likely:
A. Late menopause
B. Menopause transition
C. Postmenopause
Correct Answer: B
Rationale: The menopause transition (STRAW stages -2 to -1) involves cycle irregularity
and vasomotor symptoms; late menopause (A) is not a STRAW term, and
postmenopause (C) begins after 12 months of amenorrhea (Domain 1:
Physiology/Pathophysiology, 4%).
2. Which hormonal change primarily drives vasomotor symptoms during the menopause
transition?
A. Stable estrogen levels
B. Fluctuating estradiol
C. Increased progesterone
Correct Answer: B
Rationale: Fluctuating estradiol levels trigger vasomotor symptoms; stable estrogen (A)
does not occur in transition, and progesterone (C) decreases (Domain 1:
Physiology/Pathophysiology, 5%).
3. A 35-year-old woman with primary ovarian insufficiency (POI) should be counseled on:
A. No need for hormone therapy
B. Hormone therapy until age 50 for bone and cardiovascular protection
C. Immediate discontinuation of contraception
, Correct Answer: B
Rationale: Hormone therapy is recommended for POI to mitigate risks of early estrogen
loss; no therapy (A) increases risks, and contraception (C) depends on fertility goals
(Domain 1: Physiology/Pathophysiology, 5%).
4. The mean age of natural menopause in the United States is:
A. 45 years
B. 51 years
C. 55 years
Correct Answer: B
Rationale: Demographics indicate a mean age of 51; 45 (A) is early, 55 (C) is late (Domain
1: Physiology/Pathophysiology, 5%).
5. In surgical menopause after bilateral oophorectomy, the key clinical consequence is:
A. Gradual symptom onset
B. Abrupt estrogen loss leading to severe vasomotor symptoms
C. No change in bone density
Correct Answer: B
Rationale: Abrupt loss causes immediate symptoms; gradual (A) is natural menopause,
bone density (C) decreases (Domain 1: Physiology/Pathophysiology, 5%).
6. A 52-year-old woman reports weight gain around her abdomen. This is associated with:
A. Increased estrogen
B. Central adiposity due to menopause-related metabolic changes
C. Decreased cortisol
Correct Answer: B
Rationale: Menopause promotes central fat distribution; estrogen (A) decreases, cortisol
(C) may rise but not primary (Domain 2: Symptoms and Concerns, 2%).
7. Which treatment is highly recommended by NAMS for vasomotor symptoms (VMS)?
A. Herbal supplements only
B. Cognitive behavioral therapy (CBT)
C. High-dose progesterone
Correct Answer: B
Rationale: CBT is evidence-based for VMS; herbs (A) have limited efficacy, progesterone
(C) is not first-line (Domain 2: Symptoms and Concerns, 2%).
8. Genitourinary syndrome of menopause (GSM) includes:
A. Only urinary incontinence
B. Vaginal dryness, dyspareunia, and urinary symptoms
, C. Hot flashes
Correct Answer: B
Rationale: GSM encompasses vulvovaginal and urinary changes; incontinence (A) is part
but not all, hot flashes (C) are VMS (Domain 2: Symptoms and Concerns, 2%).
9. A 55-year-old woman has sleep disturbances. The most likely menopause-related cause
is:
A. Daytime napping
B. VMS disrupting sleep
C. Increased caffeine intake
Correct Answer: B
Rationale: VMS often cause awakenings; napping (A) or caffeine (C) are behavioral
(Domain 2: Symptoms and Concerns, 2%).
10. Which is a common sexual health concern in menopause?
A. Increased libido
B. Decreased lubrication and arousal
C. No changes
Correct Answer: B
Rationale: Estrogen decline affects lubrication; increased libido (A) uncommon, no
changes (C) inaccurate (Domain 2: Symptoms and Concerns, 2%).
11. Abnormal uterine bleeding in perimenopause requires evaluation for:
A. Always benign causes
B. Endometrial hyperplasia or cancer
C. No workup needed
Correct Answer: B
Rationale: PALM-COEIN classification guides, cancer risk increases; benign (A) not
always, no workup (C) risky (Domain 2: Symptoms and Concerns, 2%).
12. Migraine headaches in menopause may be influenced by:
A. Stable hormones
B. Fluctuating estrogen
C. Increased progesterone
Correct Answer: B
Rationale: Estrogen fluctuations trigger migraines; stable (A) less likely, progesterone (C)
not primary (Domain 3: Health Disorders in Midlife, 2%).
13. A 60-year-old woman has hypertension. Menopause-related risk is:
A. Decreased blood pressure
