NAMS MENOPAUSE CERTIFICATION
EXAM 2025 | ACTUAL REAL EXAM TEST
BANK CURRENTLY TESTING
VERSIONS WITH 135 QUESTIONS AND
ANSWERS
1. Which of the following best defines menopause?
A. Irregular menstrual cycles for one year
B. Absence of menses for 12 consecutive months not due to other causes
C. Natural cessation of estrogen production after age 60
D. Laboratory-confirmed follicle-stimulating hormone (FSH) > 50 mIU/mL
Answer: B. Rationale: Menopause is clinically defined as 12 consecutive months of
amenorrhea not explained by other causes.
2. The most reliable single laboratory marker for ovarian reserve in perimenopause is:
A. FSH measured randomly
B. Estradiol (E2) level
C. Anti-Müllerian hormone (AMH)
D. Luteinizing hormone (LH) peak
Answer: C. Rationale: AMH reflects antral follicle pool and is relatively stable across the
cycle, making it useful for ovarian reserve assessment.
3. Which symptom is most directly caused by estrogen deficiency at the urogenital tissues?
A. Hot flashes
B. Vaginal dryness and dyspareunia
C. Urinary incontinence from pelvic floor weakness
D. Depression
Answer: B. Rationale: Estrogen deficiency leads to thinning and decreased lubrication
of vaginal mucosa causing dryness and painful intercourse.
4. First-line systemic therapy for moderate-to-severe vasomotor symptoms in a healthy
woman without contraindications is:
A. Selective serotonin reuptake inhibitor (SSRI)
B. Gabapentin
C. Systemic estrogen therapy (HT)
D. Ospemifene
Answer: C. Rationale: Systemic estrogen therapy is the most effective treatment for
vasomotor symptoms when not contraindicated.
5. Absolute contraindications to systemic estrogen therapy include all EXCEPT:
A. Current breast cancer
B. Active liver disease
C. Unexplained vaginal bleeding
D. Controlled hypertension on medication
Answer: D. Rationale: Hypertension controlled on medication is not an absolute
contraindication; active breast cancer, liver disease, and unexplained bleeding are.
,6. In a woman with an intact uterus, adding a progestogen to systemic estrogen therapy is
required to:
A. Reduce vasomotor symptoms further
B. Prevent endometrial hyperplasia and cancer
C. Improve libido
D. Treat urinary urgency
Answer: B. Rationale: Progestogen protects the endometrium from unopposed
estrogen-induced hyperplasia in women with a uterus.
7. For a woman with bothersome vulvovaginal atrophy only, the recommended initial
therapy is:
A. Systemic estrogen pill
B. Vaginal (local) estrogen therapy
C. Oral bisphosphonate
D. Systemic testosterone
Answer: B. Rationale: Local vaginal estrogen treats urogenital symptoms effectively
with minimal systemic exposure.
8. The Women’s Health Initiative (WHI) trial found that combined estrogen-progestin
therapy (CEE+MPA) was associated with:
A. Decreased risk of breast cancer and increased stroke risk
B. Increased risk of CHD, stroke, VTE, and breast cancer
C. No changes in cardiovascular outcomes
D. Decreased risk of colorectal cancer and hip fracture only
Answer: B. Rationale: WHI reported increased risks of coronary heart disease, stroke,
venous thromboembolism, and breast cancer for combined therapy in the study
population.
9. How does timing hypothesis influence HT recommendations?
A. Start HT only after 10 years since menopause for benefits
B. Initiating HT closer to menopause (<10 years) may have more cardiovascular benefit
and less risk
C. Timing hypothesis only applies to oral contraceptives
D. HT timing is irrelevant to outcomes
Answer: B. Rationale: Evidence suggests earlier initiation of HT (near menopause
onset) may offer more favorable cardiovascular risk profiles than starting late.
10. Which progestogen has the strongest evidence for endometrial protection when used
with systemic estrogen?
A. Micronized progesterone
B. Norethindrone acetate
C. Medroxyprogesterone acetate (MPA)
D. Levonorgestrel intrauterine system (LNG-IUS) is also effective
Answer: D. Rationale: Multiple progestogens (including MPA, micronized progesterone,
NETA) protect the endometrium; LNG-IUS provides strong local progestogenic effect
and is an effective option.
11. A 52-year-old woman with a history of estrogen receptor–positive breast cancer asks
about HT for severe hot flashes. Best recommendation:
A. Systemic estrogen is appropriate
B. Vaginal estrogen is safe without discussion with oncologist
C. Avoid systemic HT; consider nonhormonal options and coordinate with oncology
D. Prescribe combined HT for short-term relief
Answer: C. Rationale: HT is generally contraindicated in active or recent estrogen
receptor–positive breast cancer; nonhormonal therapies and oncologist input are
recommended.
, 12. Nonhormonal FDA-approved medication for vasomotor symptoms is:
A. Ospemifene
B. Paroxetine 7.5 mg (low-dose)
C. Gabapentin XR only
D. Topical testosterone
Answer: B. Rationale: Low-dose paroxetine mesylate 7.5 mg is FDA-approved for
menopausal vasomotor symptoms.
13. Selective estrogen receptor modulators (SERMs) like raloxifene primarily:
A. Increase risk of endometrial hyperplasia
B. Provide estrogenic action on bone and antagonistic action on breast
C. Are first-line for vasomotor symptoms
D. Decrease bone density
Answer: B. Rationale: Raloxifene is estrogenic on bone (reduces fracture risk) and anti-
estrogenic in breast tissue; it does not stimulate the endometrium.
14. Which of the following is the most common adverse effect of systemic estrogen therapy?
A. Weight loss
B. Breast tenderness and vaginal bleeding
C. Severe liver failure
D. Myocardial infarction within weeks
Answer: B. Rationale: Common side effects include breast tenderness and irregular
vaginal bleeding (particularly initially).
15. For fracture prevention in postmenopausal women at high fracture risk, the most
appropriate first-line therapy is often:
A. Systemic estrogen alone
B. Bisphosphonates (e.g., alendronate)
C. Topical estrogen cream
D. Paroxetine
Answer: B. Rationale: Bisphosphonates are first-line pharmacologic therapy for
osteoporosis and fracture prevention in high-risk postmenopausal women.
16. Which test is recommended to screen for osteoporosis in women ≥65 years?
A. Serum calcium only
B. Dual-energy X-ray absorptiometry (DXA) scan of hip and spine
C. Measurement of FSH
D. Bone turnover markers only
Answer: B. Rationale: DXA scanning of the hip and lumbar spine is the standard
screening test for osteoporosis.
17. The FRAX tool estimates:
A. 10-year probability of major osteoporotic fracture and hip fracture
B. Lifetime fracture risk only
C. Immediate fracture risk in the next month
D. Bone density score equivalent
Answer: A. Rationale: FRAX estimates 10-year probability of major osteoporotic and hip
fractures using clinical risk factors +/- BMD.
18. Which of the following reduces hot flashes via modulation of thermoregulatory centers
and is effective off-label?
A. Oral estrogens only
B. Gabapentin and pregabalin
C. Topical progesterone
D. Local vaginal estrogen
Answer: B. Rationale: Gabapentin and pregabalin reduce vasomotor symptoms by
central nervous system mechanisms and are used off-label.
EXAM 2025 | ACTUAL REAL EXAM TEST
BANK CURRENTLY TESTING
VERSIONS WITH 135 QUESTIONS AND
ANSWERS
1. Which of the following best defines menopause?
A. Irregular menstrual cycles for one year
B. Absence of menses for 12 consecutive months not due to other causes
C. Natural cessation of estrogen production after age 60
D. Laboratory-confirmed follicle-stimulating hormone (FSH) > 50 mIU/mL
Answer: B. Rationale: Menopause is clinically defined as 12 consecutive months of
amenorrhea not explained by other causes.
2. The most reliable single laboratory marker for ovarian reserve in perimenopause is:
A. FSH measured randomly
B. Estradiol (E2) level
C. Anti-Müllerian hormone (AMH)
D. Luteinizing hormone (LH) peak
Answer: C. Rationale: AMH reflects antral follicle pool and is relatively stable across the
cycle, making it useful for ovarian reserve assessment.
3. Which symptom is most directly caused by estrogen deficiency at the urogenital tissues?
A. Hot flashes
B. Vaginal dryness and dyspareunia
C. Urinary incontinence from pelvic floor weakness
D. Depression
Answer: B. Rationale: Estrogen deficiency leads to thinning and decreased lubrication
of vaginal mucosa causing dryness and painful intercourse.
4. First-line systemic therapy for moderate-to-severe vasomotor symptoms in a healthy
woman without contraindications is:
A. Selective serotonin reuptake inhibitor (SSRI)
B. Gabapentin
C. Systemic estrogen therapy (HT)
D. Ospemifene
Answer: C. Rationale: Systemic estrogen therapy is the most effective treatment for
vasomotor symptoms when not contraindicated.
5. Absolute contraindications to systemic estrogen therapy include all EXCEPT:
A. Current breast cancer
B. Active liver disease
C. Unexplained vaginal bleeding
D. Controlled hypertension on medication
Answer: D. Rationale: Hypertension controlled on medication is not an absolute
contraindication; active breast cancer, liver disease, and unexplained bleeding are.
,6. In a woman with an intact uterus, adding a progestogen to systemic estrogen therapy is
required to:
A. Reduce vasomotor symptoms further
B. Prevent endometrial hyperplasia and cancer
C. Improve libido
D. Treat urinary urgency
Answer: B. Rationale: Progestogen protects the endometrium from unopposed
estrogen-induced hyperplasia in women with a uterus.
7. For a woman with bothersome vulvovaginal atrophy only, the recommended initial
therapy is:
A. Systemic estrogen pill
B. Vaginal (local) estrogen therapy
C. Oral bisphosphonate
D. Systemic testosterone
Answer: B. Rationale: Local vaginal estrogen treats urogenital symptoms effectively
with minimal systemic exposure.
8. The Women’s Health Initiative (WHI) trial found that combined estrogen-progestin
therapy (CEE+MPA) was associated with:
A. Decreased risk of breast cancer and increased stroke risk
B. Increased risk of CHD, stroke, VTE, and breast cancer
C. No changes in cardiovascular outcomes
D. Decreased risk of colorectal cancer and hip fracture only
Answer: B. Rationale: WHI reported increased risks of coronary heart disease, stroke,
venous thromboembolism, and breast cancer for combined therapy in the study
population.
9. How does timing hypothesis influence HT recommendations?
A. Start HT only after 10 years since menopause for benefits
B. Initiating HT closer to menopause (<10 years) may have more cardiovascular benefit
and less risk
C. Timing hypothesis only applies to oral contraceptives
D. HT timing is irrelevant to outcomes
Answer: B. Rationale: Evidence suggests earlier initiation of HT (near menopause
onset) may offer more favorable cardiovascular risk profiles than starting late.
10. Which progestogen has the strongest evidence for endometrial protection when used
with systemic estrogen?
A. Micronized progesterone
B. Norethindrone acetate
C. Medroxyprogesterone acetate (MPA)
D. Levonorgestrel intrauterine system (LNG-IUS) is also effective
Answer: D. Rationale: Multiple progestogens (including MPA, micronized progesterone,
NETA) protect the endometrium; LNG-IUS provides strong local progestogenic effect
and is an effective option.
11. A 52-year-old woman with a history of estrogen receptor–positive breast cancer asks
about HT for severe hot flashes. Best recommendation:
A. Systemic estrogen is appropriate
B. Vaginal estrogen is safe without discussion with oncologist
C. Avoid systemic HT; consider nonhormonal options and coordinate with oncology
D. Prescribe combined HT for short-term relief
Answer: C. Rationale: HT is generally contraindicated in active or recent estrogen
receptor–positive breast cancer; nonhormonal therapies and oncologist input are
recommended.
, 12. Nonhormonal FDA-approved medication for vasomotor symptoms is:
A. Ospemifene
B. Paroxetine 7.5 mg (low-dose)
C. Gabapentin XR only
D. Topical testosterone
Answer: B. Rationale: Low-dose paroxetine mesylate 7.5 mg is FDA-approved for
menopausal vasomotor symptoms.
13. Selective estrogen receptor modulators (SERMs) like raloxifene primarily:
A. Increase risk of endometrial hyperplasia
B. Provide estrogenic action on bone and antagonistic action on breast
C. Are first-line for vasomotor symptoms
D. Decrease bone density
Answer: B. Rationale: Raloxifene is estrogenic on bone (reduces fracture risk) and anti-
estrogenic in breast tissue; it does not stimulate the endometrium.
14. Which of the following is the most common adverse effect of systemic estrogen therapy?
A. Weight loss
B. Breast tenderness and vaginal bleeding
C. Severe liver failure
D. Myocardial infarction within weeks
Answer: B. Rationale: Common side effects include breast tenderness and irregular
vaginal bleeding (particularly initially).
15. For fracture prevention in postmenopausal women at high fracture risk, the most
appropriate first-line therapy is often:
A. Systemic estrogen alone
B. Bisphosphonates (e.g., alendronate)
C. Topical estrogen cream
D. Paroxetine
Answer: B. Rationale: Bisphosphonates are first-line pharmacologic therapy for
osteoporosis and fracture prevention in high-risk postmenopausal women.
16. Which test is recommended to screen for osteoporosis in women ≥65 years?
A. Serum calcium only
B. Dual-energy X-ray absorptiometry (DXA) scan of hip and spine
C. Measurement of FSH
D. Bone turnover markers only
Answer: B. Rationale: DXA scanning of the hip and lumbar spine is the standard
screening test for osteoporosis.
17. The FRAX tool estimates:
A. 10-year probability of major osteoporotic fracture and hip fracture
B. Lifetime fracture risk only
C. Immediate fracture risk in the next month
D. Bone density score equivalent
Answer: A. Rationale: FRAX estimates 10-year probability of major osteoporotic and hip
fractures using clinical risk factors +/- BMD.
18. Which of the following reduces hot flashes via modulation of thermoregulatory centers
and is effective off-label?
A. Oral estrogens only
B. Gabapentin and pregabalin
C. Topical progesterone
D. Local vaginal estrogen
Answer: B. Rationale: Gabapentin and pregabalin reduce vasomotor symptoms by
central nervous system mechanisms and are used off-label.
