NAMS MENOPAUSE CERTIFICATION EXAM|
ACTUAL EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED A+
LATEST
1
A 52-year-old woman reports 3 months of irregular periods followed by a 45-day
interval without menses, and is now experiencing hot flashes and night sweats.
Which stage of the menopause transition (according to the STRAW+10 system) is
most consistent with her presentation?
A. Early reproductive (-3b)
B. Late reproductive (-3a)
C. Early menopausal transition (-2)
D. Late menopausal transition (-1)
Answer: C. Early menopausal transition (-2).
Rationale: In the STRAW+10 staging system, the early menopausal transition
(stage -2) is characterized by persistent differences in cycle length of 7+ days. The
late transition (-1) is marked by 60+ days of amenorrhea or 2+ skipped cycles.
Here she is in the phase of irregularity (~45 days) with vasomotor symptoms, so an
early transition stage is most appropriate.
2
A 49-year-old woman without history of hysterectomy complains of bothersome
hot flashes and vaginal dryness. She has no contraindications to hormone therapy.
Which of the following is the most appropriate hormone therapy regimen?
A. Estrogen alone (unopposed)
B. Estrogen + progestogen (combined)
C. Progestogen alone
D. Selective estrogen receptor modulator (SERM) only
,Answer: B. Estrogen + progestogen (combined).
Rationale: In a woman with an intact uterus, the addition of a progestogen to
estrogen is required to prevent endometrial hyperplasia and cancer. Estrogen alone
(A) is only appropriate when the uterus has been removed. Progestogen alone (C)
or SERM alone (D) are not optimal first‐line hormone therapy regimens for
vasomotor + vaginal symptoms in this scenario.
3
Which of the following non‐hormonal interventions is strongly recommended by
The Menopause Society for management of vasomotor symptoms?
A. High-dose vitamin E
B. Cognitive behavioural therapy (CBT)
C. Daily swapping of hot/cold packs
D. Soy isoflavone supplements at high doses
Answer: B. Cognitive behavioural therapy (CBT).
Rationale: The Menopause Society guidelines include evidence-based non‐
hormonal treatments such as CBT and clinical hypnosis for vasomotor symptoms.
High-dose vitamin E lacks robust evidence, hot/cold packs may help symptom
relief but are not formal guideline-strong recommendations, and high-dose soy
isoflavones have inconsistent data and are not strongly recommended.
4
A 57-year-old postmenopausal woman presents with newly diagnosed
osteoporosis, T-score –2.6, and a history of hysterectomy (uterus removed). She
has no contraindications to hormone therapy. Which factor supports the use of
hormone therapy for her bone health?
A. She is well beyond the window of benefit (> 10 years postmenopause)
B. She has a uterus (so progestogen needed)
C. She is within 10 years of menopause onset and has no uterine tissue requiring
protection
D. She is under 60 and has no contraindications
,Answer: D. She is under 60 and has no contraindications.
Rationale: Hormone therapy is more beneficial for bone health when started
within about 10 years of menopause or before age 60 in appropriate candidates
without contraindications. Although she has had a hysterectomy (so estrogen alone
is acceptable), the key supportive factor is her age (<60) and being within a
reasonable window of benefit. Option C is incorrect because although she has no
uterus, the statement “within 10 years of menopause onset” is less specific; option
D is broader and correct.
5
Which laboratory test is not recommended to diagnose menopause in a woman
who is 52 years old with classic menopausal symptoms?
A. FSH level
B. AMH (anti-Müllerian hormone)
C. Estradiol level
D. No laboratory test is needed
Answer: D. No laboratory test is needed.
Rationale: For a woman ≥45 years with 12 months of amenorrhea and
characteristic symptoms, menopause is a clinical diagnosis and no hormonal test is
needed. FSH and estradiol levels fluctuate widely and do not reliably confirm
menopause. AMH is not recommended for routine menopause diagnosis.
6
A 50-year-old woman has been taking continuous combined hormone therapy
(estrogen + progestogen) for 8 years since initiating at age 42 for vasomotor
symptoms. She now questions whether she still needs to continue therapy. Which
statement is most appropriate?
A. Stop therapy immediately to minimize breast cancer risk
B. Continue indefinitely because age does not matter
C. Reassess risk/benefit, and consider tapering if symptoms are controlled and no
ongoing indication
D. Switch to estrogen alone now that symptoms are gone
, Answer: C. Reassess risk/benefit, and consider tapering if symptoms are
controlled and no ongoing indication.
Rationale: The decision to continue hormone therapy beyond about 5–10 years
should be individualized based on symptoms, risk profile (breast cancer,
cardiovascular, VTE), and patient preference. If indications (e.g., vasomotor
symptoms, osteoporosis) persist and risks remain low, continuation may be
reasonable. Immediate cessation (A) is not required if benefits outweigh risks;
continuing indefinitely without reassessment (B) is not guideline‐based; switching
to estrogen alone (D) is only safe if uterus removed.
7
Which of the following statements about transdermal versus oral estrogen is true
regarding risk profiles?
A. Transdermal estrogen increases triglycerides more than oral estrogen
B. Oral estrogen has lower risk of venous thromboembolism (VTE) than
transdermal
C. Transdermal estrogen may have lower VTE and stroke risk than oral estrogen
D. Route of estrogen does not affect risk of clotting or stroke
Answer: C. Transdermal estrogen may have lower VTE and stroke risk than
oral estrogen.
Rationale: Evidence suggests that transdermal estrogen bypasses first-pass hepatic
metabolism, which may reduce impact on clotting factors and triglycerides, and
may reduce VTE/stroke risk compared with oral formulations. Oral estrogen tends
to increase triglycerides and may have higher VTE risk.
8
A 53-year-old woman reports vaginal dryness, dyspareunia, and recurrent urinary
tract infections. She is not interested in systemic hormone therapy. Which local
therapy is most appropriate?
A. Oral SERMs only
B. Low-dose vaginal estrogen therapy
ACTUAL EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED A+
LATEST
1
A 52-year-old woman reports 3 months of irregular periods followed by a 45-day
interval without menses, and is now experiencing hot flashes and night sweats.
Which stage of the menopause transition (according to the STRAW+10 system) is
most consistent with her presentation?
A. Early reproductive (-3b)
B. Late reproductive (-3a)
C. Early menopausal transition (-2)
D. Late menopausal transition (-1)
Answer: C. Early menopausal transition (-2).
Rationale: In the STRAW+10 staging system, the early menopausal transition
(stage -2) is characterized by persistent differences in cycle length of 7+ days. The
late transition (-1) is marked by 60+ days of amenorrhea or 2+ skipped cycles.
Here she is in the phase of irregularity (~45 days) with vasomotor symptoms, so an
early transition stage is most appropriate.
2
A 49-year-old woman without history of hysterectomy complains of bothersome
hot flashes and vaginal dryness. She has no contraindications to hormone therapy.
Which of the following is the most appropriate hormone therapy regimen?
A. Estrogen alone (unopposed)
B. Estrogen + progestogen (combined)
C. Progestogen alone
D. Selective estrogen receptor modulator (SERM) only
,Answer: B. Estrogen + progestogen (combined).
Rationale: In a woman with an intact uterus, the addition of a progestogen to
estrogen is required to prevent endometrial hyperplasia and cancer. Estrogen alone
(A) is only appropriate when the uterus has been removed. Progestogen alone (C)
or SERM alone (D) are not optimal first‐line hormone therapy regimens for
vasomotor + vaginal symptoms in this scenario.
3
Which of the following non‐hormonal interventions is strongly recommended by
The Menopause Society for management of vasomotor symptoms?
A. High-dose vitamin E
B. Cognitive behavioural therapy (CBT)
C. Daily swapping of hot/cold packs
D. Soy isoflavone supplements at high doses
Answer: B. Cognitive behavioural therapy (CBT).
Rationale: The Menopause Society guidelines include evidence-based non‐
hormonal treatments such as CBT and clinical hypnosis for vasomotor symptoms.
High-dose vitamin E lacks robust evidence, hot/cold packs may help symptom
relief but are not formal guideline-strong recommendations, and high-dose soy
isoflavones have inconsistent data and are not strongly recommended.
4
A 57-year-old postmenopausal woman presents with newly diagnosed
osteoporosis, T-score –2.6, and a history of hysterectomy (uterus removed). She
has no contraindications to hormone therapy. Which factor supports the use of
hormone therapy for her bone health?
A. She is well beyond the window of benefit (> 10 years postmenopause)
B. She has a uterus (so progestogen needed)
C. She is within 10 years of menopause onset and has no uterine tissue requiring
protection
D. She is under 60 and has no contraindications
,Answer: D. She is under 60 and has no contraindications.
Rationale: Hormone therapy is more beneficial for bone health when started
within about 10 years of menopause or before age 60 in appropriate candidates
without contraindications. Although she has had a hysterectomy (so estrogen alone
is acceptable), the key supportive factor is her age (<60) and being within a
reasonable window of benefit. Option C is incorrect because although she has no
uterus, the statement “within 10 years of menopause onset” is less specific; option
D is broader and correct.
5
Which laboratory test is not recommended to diagnose menopause in a woman
who is 52 years old with classic menopausal symptoms?
A. FSH level
B. AMH (anti-Müllerian hormone)
C. Estradiol level
D. No laboratory test is needed
Answer: D. No laboratory test is needed.
Rationale: For a woman ≥45 years with 12 months of amenorrhea and
characteristic symptoms, menopause is a clinical diagnosis and no hormonal test is
needed. FSH and estradiol levels fluctuate widely and do not reliably confirm
menopause. AMH is not recommended for routine menopause diagnosis.
6
A 50-year-old woman has been taking continuous combined hormone therapy
(estrogen + progestogen) for 8 years since initiating at age 42 for vasomotor
symptoms. She now questions whether she still needs to continue therapy. Which
statement is most appropriate?
A. Stop therapy immediately to minimize breast cancer risk
B. Continue indefinitely because age does not matter
C. Reassess risk/benefit, and consider tapering if symptoms are controlled and no
ongoing indication
D. Switch to estrogen alone now that symptoms are gone
, Answer: C. Reassess risk/benefit, and consider tapering if symptoms are
controlled and no ongoing indication.
Rationale: The decision to continue hormone therapy beyond about 5–10 years
should be individualized based on symptoms, risk profile (breast cancer,
cardiovascular, VTE), and patient preference. If indications (e.g., vasomotor
symptoms, osteoporosis) persist and risks remain low, continuation may be
reasonable. Immediate cessation (A) is not required if benefits outweigh risks;
continuing indefinitely without reassessment (B) is not guideline‐based; switching
to estrogen alone (D) is only safe if uterus removed.
7
Which of the following statements about transdermal versus oral estrogen is true
regarding risk profiles?
A. Transdermal estrogen increases triglycerides more than oral estrogen
B. Oral estrogen has lower risk of venous thromboembolism (VTE) than
transdermal
C. Transdermal estrogen may have lower VTE and stroke risk than oral estrogen
D. Route of estrogen does not affect risk of clotting or stroke
Answer: C. Transdermal estrogen may have lower VTE and stroke risk than
oral estrogen.
Rationale: Evidence suggests that transdermal estrogen bypasses first-pass hepatic
metabolism, which may reduce impact on clotting factors and triglycerides, and
may reduce VTE/stroke risk compared with oral formulations. Oral estrogen tends
to increase triglycerides and may have higher VTE risk.
8
A 53-year-old woman reports vaginal dryness, dyspareunia, and recurrent urinary
tract infections. She is not interested in systemic hormone therapy. Which local
therapy is most appropriate?
A. Oral SERMs only
B. Low-dose vaginal estrogen therapy
