NAMS MENOPAUSE CERTIFICATION
EXAM 2025 TEST BANK WITH
CURRENTLY TESTING VERSIONS WITH
135 QUESTIONS EACH WITH
RATIONALE
1. A 52-year-old woman presents with hot flashes and night sweats for the past 8 months. Her
last menstrual period was 11 months ago. Which term best describes her reproductive stage?
A. Perimenopause
B. Early postmenopause
C. Late postmenopause
D. Menopause transition
✅ Answer: A. Perimenopause
Rationale: She is still within 12 months of her last menstrual period; menopause is defined
retrospectively after 12 months of amenorrhea.
2. The primary hormone responsible for vasomotor symptoms is:
A. Progesterone
B. Estradiol
C. FSH
D. Testosterone
✅ Answer: B. Estradiol
Rationale: Declining estrogen levels during menopause disrupt hypothalamic
thermoregulation, causing hot flashes.
3. Which route of estrogen therapy is least likely to increase triglycerides?
A. Oral conjugated estrogen
B. Transdermal estradiol patch
C. Oral micronized estradiol
D. Vaginal estrogen cream
✅ Answer: B. Transdermal estradiol patch
Rationale: Transdermal estrogen bypasses hepatic first-pass metabolism, avoiding significant
effects on triglycerides.
,4. A 54-year-old woman on combined estrogen-progestogen therapy develops postmenopausal
bleeding. The next best step is:
A. Increase progesterone dose
B. Stop therapy immediately
C. Perform a transvaginal ultrasound
D. Reassure her it’s normal
✅ Answer: C. Perform a transvaginal ultrasound
Rationale: Postmenopausal bleeding warrants endometrial evaluation; ultrasound is the first-
line test.
5. The most effective treatment for vasomotor symptoms is:
A. SSRIs
B. Black cohosh
C. Hormone therapy
D. Gabapentin
✅ Answer: C. Hormone therapy
Rationale: Estrogen therapy remains the gold standard for moderate to severe hot flashes
when not contraindicated.
6. Which nonhormonal agent has the best evidence for treating vasomotor symptoms?
A. Clonidine
B. Paroxetine
C. Vitamin E
D. Evening primrose oil
✅ Answer: B. Paroxetine
Rationale: Paroxetine, an SSRI, is FDA-approved for hot flashes; others have less consistent
evidence.
7. A 60-year-old woman presents 10 years post-menopause with new hot flashes. She has
hypertension and obesity. The best management is:
A. Start oral estrogen
B. Start transdermal estrogen
C. Recommend nonhormonal therapy
D. Prescribe conjugated estrogen and MPA
✅ Answer: C. Recommend nonhormonal therapy
Rationale: Hormone therapy is most beneficial within 10 years of menopause onset; starting
late increases risk.
,8. The addition of progestogen to estrogen therapy is required in women with:
A. Prior hysterectomy
B. Intact uterus
C. Osteoporosis
D. Vasomotor symptoms
✅ Answer: B. Intact uterus
Rationale: Progestogen protects against estrogen-induced endometrial hyperplasia and
carcinoma.
9. Which bone site is most predictive of fracture risk?
A. Lumbar spine
B. Radius
C. Femoral neck
D. Calcaneus
✅ Answer: C. Femoral neck
Rationale: The femoral neck measurement correlates most strongly with hip fracture risk.
10. The recommended daily intake of calcium for postmenopausal women is:
A. 500 mg
B. 800 mg
C. 1200 mg
D. 2000 mg
✅ Answer: C. 1200 mg
Rationale: Postmenopausal women should aim for 1200 mg/day from diet and supplements
combined.
11. A woman on hormone therapy for 5 years asks about discontinuing it. The best approach is
to:
A. Stop abruptly
B. Taper gradually
C. Continue indefinitely
D. Add testosterone first
✅ Answer: B. Taper gradually
Rationale: Gradual tapering reduces recurrence of vasomotor symptoms; individualized based
on symptom return.
12. Which of the following is not a contraindication to systemic hormone therapy?
A. Unexplained vaginal bleeding
B. History of breast cancer
, C. History of DVT
D. Controlled hypertension
✅ Answer: D. Controlled hypertension
Rationale: Controlled hypertension is not a contraindication, though blood pressure should be
monitored.
13. The primary mechanism of bone loss after menopause is:
A. Reduced calcium absorption
B. Increased parathyroid hormone
C. Decreased estrogen
D. Vitamin D deficiency
✅ Answer: C. Decreased estrogen
Rationale: Estrogen deficiency increases osteoclast activity, leading to accelerated bone
resorption.
14. The preferred first-line therapy for genitourinary syndrome of menopause (GSM) is:
A. Systemic estrogen
B. Local vaginal estrogen
C. Oral estrogen
D. Androgen therapy
✅ Answer: B. Local vaginal estrogen
Rationale: Topical estrogen is safe and effective for GSM; minimal systemic absorption.
15. The most common cause of sexual dysfunction in postmenopausal women is:
A. Depression
B. Androgen deficiency
C. Relationship issues
D. Vaginal dryness
✅ Answer: D. Vaginal dryness
Rationale: Estrogen loss causes thinning and dryness of vaginal mucosa, leading to
dyspareunia.
16. Estrogen therapy improves:
A. Cognitive performance
B. Hot flashes
C. Memory recall
D. Migraine frequency
EXAM 2025 TEST BANK WITH
CURRENTLY TESTING VERSIONS WITH
135 QUESTIONS EACH WITH
RATIONALE
1. A 52-year-old woman presents with hot flashes and night sweats for the past 8 months. Her
last menstrual period was 11 months ago. Which term best describes her reproductive stage?
A. Perimenopause
B. Early postmenopause
C. Late postmenopause
D. Menopause transition
✅ Answer: A. Perimenopause
Rationale: She is still within 12 months of her last menstrual period; menopause is defined
retrospectively after 12 months of amenorrhea.
2. The primary hormone responsible for vasomotor symptoms is:
A. Progesterone
B. Estradiol
C. FSH
D. Testosterone
✅ Answer: B. Estradiol
Rationale: Declining estrogen levels during menopause disrupt hypothalamic
thermoregulation, causing hot flashes.
3. Which route of estrogen therapy is least likely to increase triglycerides?
A. Oral conjugated estrogen
B. Transdermal estradiol patch
C. Oral micronized estradiol
D. Vaginal estrogen cream
✅ Answer: B. Transdermal estradiol patch
Rationale: Transdermal estrogen bypasses hepatic first-pass metabolism, avoiding significant
effects on triglycerides.
,4. A 54-year-old woman on combined estrogen-progestogen therapy develops postmenopausal
bleeding. The next best step is:
A. Increase progesterone dose
B. Stop therapy immediately
C. Perform a transvaginal ultrasound
D. Reassure her it’s normal
✅ Answer: C. Perform a transvaginal ultrasound
Rationale: Postmenopausal bleeding warrants endometrial evaluation; ultrasound is the first-
line test.
5. The most effective treatment for vasomotor symptoms is:
A. SSRIs
B. Black cohosh
C. Hormone therapy
D. Gabapentin
✅ Answer: C. Hormone therapy
Rationale: Estrogen therapy remains the gold standard for moderate to severe hot flashes
when not contraindicated.
6. Which nonhormonal agent has the best evidence for treating vasomotor symptoms?
A. Clonidine
B. Paroxetine
C. Vitamin E
D. Evening primrose oil
✅ Answer: B. Paroxetine
Rationale: Paroxetine, an SSRI, is FDA-approved for hot flashes; others have less consistent
evidence.
7. A 60-year-old woman presents 10 years post-menopause with new hot flashes. She has
hypertension and obesity. The best management is:
A. Start oral estrogen
B. Start transdermal estrogen
C. Recommend nonhormonal therapy
D. Prescribe conjugated estrogen and MPA
✅ Answer: C. Recommend nonhormonal therapy
Rationale: Hormone therapy is most beneficial within 10 years of menopause onset; starting
late increases risk.
,8. The addition of progestogen to estrogen therapy is required in women with:
A. Prior hysterectomy
B. Intact uterus
C. Osteoporosis
D. Vasomotor symptoms
✅ Answer: B. Intact uterus
Rationale: Progestogen protects against estrogen-induced endometrial hyperplasia and
carcinoma.
9. Which bone site is most predictive of fracture risk?
A. Lumbar spine
B. Radius
C. Femoral neck
D. Calcaneus
✅ Answer: C. Femoral neck
Rationale: The femoral neck measurement correlates most strongly with hip fracture risk.
10. The recommended daily intake of calcium for postmenopausal women is:
A. 500 mg
B. 800 mg
C. 1200 mg
D. 2000 mg
✅ Answer: C. 1200 mg
Rationale: Postmenopausal women should aim for 1200 mg/day from diet and supplements
combined.
11. A woman on hormone therapy for 5 years asks about discontinuing it. The best approach is
to:
A. Stop abruptly
B. Taper gradually
C. Continue indefinitely
D. Add testosterone first
✅ Answer: B. Taper gradually
Rationale: Gradual tapering reduces recurrence of vasomotor symptoms; individualized based
on symptom return.
12. Which of the following is not a contraindication to systemic hormone therapy?
A. Unexplained vaginal bleeding
B. History of breast cancer
, C. History of DVT
D. Controlled hypertension
✅ Answer: D. Controlled hypertension
Rationale: Controlled hypertension is not a contraindication, though blood pressure should be
monitored.
13. The primary mechanism of bone loss after menopause is:
A. Reduced calcium absorption
B. Increased parathyroid hormone
C. Decreased estrogen
D. Vitamin D deficiency
✅ Answer: C. Decreased estrogen
Rationale: Estrogen deficiency increases osteoclast activity, leading to accelerated bone
resorption.
14. The preferred first-line therapy for genitourinary syndrome of menopause (GSM) is:
A. Systemic estrogen
B. Local vaginal estrogen
C. Oral estrogen
D. Androgen therapy
✅ Answer: B. Local vaginal estrogen
Rationale: Topical estrogen is safe and effective for GSM; minimal systemic absorption.
15. The most common cause of sexual dysfunction in postmenopausal women is:
A. Depression
B. Androgen deficiency
C. Relationship issues
D. Vaginal dryness
✅ Answer: D. Vaginal dryness
Rationale: Estrogen loss causes thinning and dryness of vaginal mucosa, leading to
dyspareunia.
16. Estrogen therapy improves:
A. Cognitive performance
B. Hot flashes
C. Memory recall
D. Migraine frequency
