NAMS Menopause Exam Q-Bank – Complete
Certified Menopause Practitioner Practice
Questions with Verified Answers &
Explanations – Updated 2025/2026 Study
Resource
,A 48-year-old African-American woman presents with increasingly irregular cycles
ranging from 21 to 60 days over the past 18 months. She reports 12–15 hot flashes daily,
severe enough to interrupt work, and nightly sweats that soak the sheets. BMI is 32
kg/m², BP 128/82, mammogram normal 6 months ago. She smokes ½ ppd and drinks
2–3 glasses of wine nightly. FSH drawn on day 3 of a cycle is 28 IU/L, estradiol 180
pg/mL. According to STRAW+10 staging and NAMS 2022 guidelines, what is the most
appropriate next step?
A. Repeat FSH in 6 weeks and withhold treatment until confirmed postmenopausal
B. Begin low-dose combined oral contraceptive for cycle regulation and symptom relief
C. Initiate systemic hormone therapy with transdermal estradiol 0.0375 mg +
micronized progesterone 100 mg
D. Recommend paroxetine 7.5 mg daily and lifestyle modifications only
E. Perform endometrial biopsy immediately due to elevated estradiol
Answer-: C
Explanation: Late menopausal transition (STRAW -1) with severe VMS. She is <60 and
within the window of opportunity. Transdermal route preferred in smokers and
overweight patients (lower VTE/TG risk). Elevated estradiol is classic for LOOP events
in late transition; biopsy not indicated without abnormal bleeding. NAMS 2022 strongly
supports systemic HT as first-line for bothersome VMS in appropriate candidates.
Question 202
A 52-year-old woman underwent TAH-BSO for endometriosis 3 months ago. She now
has 20–30 severe hot flashes daily and insomnia. She has no contraindications to HT.
Which regimen provides the highest likelihood of symptom relief and long-term
bone/CV protection per NAMS?
A. Conjugated estrogens 0.45 mg + MPA 2.5 mg daily
B. Transdermal estradiol 0.05–0.1 mg/day (titrate to symptoms)
C. Oral estradiol 1 mg + norethindrone acetate 0.5 mg
D. Estradiol patch 0.05 mg twice weekly + micronized progesterone 200 mg days 1–12
monthly
E. Low-dose vaginal estradiol ring only
Answer-: B
Explanation: Surgical menopause = abrupt, severe estrogen withdrawal. NAMS
recommends systemic estrogen alone (no progestogen needed post-hysterectomy) until
,at least age 52 (average natural menopause). Transdermal avoids first-pass hepatic
effect and has the most favorable risk profile in surgical menopause.
Question 203
A 58-year-old woman, 7 years postmenopausal, presents with recurrent UTI (4 culture-
proven in past year) and new dyspareunia. Exam: pale, friable vaginal mucosa, pH 6.8.
She has no abnormal bleeding. Breast cancer history 8 years ago (ER+, treated with
mastectomy + tamoxifen ×5 years, now off all therapy). Which is the most appropriate
management?
A. Intravaginal DHEA (prasterone) 6.5 mg nightly
B. Systemic HT with CEE + bazedoxifene
C. Ospemifene 60 mg daily
D. Low-dose vaginal estradiol cream 0.5 g twice weekly
E. Fractional CO₂ laser therapy ×3 sessions
Answer-: A
Explanation: History of ER+ breast cancer = systemic HT and SERMs (ospemifene,
bazedoxifene) contraindicated or controversial. Low-dose vaginal estradiol has minimal
systemic absorption but many oncologists still prefer to avoid any estrogen. Prasterone
(DHEA) is FDA-approved for GSM, converts locally to estrogen/androgen, and has the
most favorable safety profile in breast-cancer survivors per 2022 NAMS and ASCO
guidelines.
Question 204
According to the 2022 NAMS Hormone Therapy Position Statement, which absolute
risk increase for breast cancer is correct for combined estrogen-progestogen therapy
used >5 years starting at age 52?
A. 0 additional cases per 1,000 women
B. <1 additional case per 1,000 women-years
C. 4–6 additional cases per 1,000 women over 5 years
D. 8–10 additional cases per 1,000 women over 5 years
E. >20 additional cases per 1,000 women
Answer-: C
Explanation: WHI long-term follow-up and meta-analyses cited by NAMS: combined
EPT started <60 years increases breast cancer risk by approximately 4–6 additional
, cases per 1,000 women over 5 years of use (roughly +1 per 1,000 woman-years).
Estrogen-only therapy shows no increase or slight decrease.
Question 205
A 62-year-old woman (12 years post-FMP) with osteoporosis (T-score –2.8 spine) and
severe VMS asks about HT. She has no contraindications. What is the most appropriate
recommendation?
A. Start transdermal estradiol + micronized progesterone; HT is first-line for
osteoporosis
B. HT is no longer indicated for bone protection at her age; start denosumab or
zoledronic acid
C. Offer HT for VMS but add alendronate for bone because HT benefit uncertain >10
years postmenopause
D. HT contraindicated due to age >60
E. Use raloxifene for both VMS and bone
Answer-: B
Explanation: NAMS 2022: HT is FDA-approved for prevention but not treatment of
postmenopausal osteoporosis. After age 60 or >10 years post-FMP, risks generally
outweigh benefits for bone alone. Treat osteoporosis with proven agents
(bisphosphonates, denosumab, anabolic agents). HT can still be considered for severe
VMS if patient accepts risk.
A 55-year-old woman, 4 years postmenopausal, presents complaining only of vaginal
dryness and pain with intercourse twice weekly. She has no vasomotor symptoms, no
bleeding, normal mammogram 4 months ago, and an intact uterus. Exam shows thin,
pale mucosa and vaginal pH 6.5. She specifically asks, “Do I still need a progestin if I
only want something in the vagina?” According to the 2022 NAMS Position Statement
on Hormone Therapy, what is the most appropriate response and management?
A. Yes – all postmenopausal women with a uterus require cyclic progestin even with
low-dose vaginal estrogen
B. No – low-dose vaginal estrogen (≤10 µg estradiol or estriol) does not require
endometrial opposition
C. Yes – start continuous micronized progesterone 100 mg daily for safety
D. No – but switch to ospemifene because it is completely non-hormonal
E. Yes – insert a levonorgestrel IUD before starting vaginal estrogen
Certified Menopause Practitioner Practice
Questions with Verified Answers &
Explanations – Updated 2025/2026 Study
Resource
,A 48-year-old African-American woman presents with increasingly irregular cycles
ranging from 21 to 60 days over the past 18 months. She reports 12–15 hot flashes daily,
severe enough to interrupt work, and nightly sweats that soak the sheets. BMI is 32
kg/m², BP 128/82, mammogram normal 6 months ago. She smokes ½ ppd and drinks
2–3 glasses of wine nightly. FSH drawn on day 3 of a cycle is 28 IU/L, estradiol 180
pg/mL. According to STRAW+10 staging and NAMS 2022 guidelines, what is the most
appropriate next step?
A. Repeat FSH in 6 weeks and withhold treatment until confirmed postmenopausal
B. Begin low-dose combined oral contraceptive for cycle regulation and symptom relief
C. Initiate systemic hormone therapy with transdermal estradiol 0.0375 mg +
micronized progesterone 100 mg
D. Recommend paroxetine 7.5 mg daily and lifestyle modifications only
E. Perform endometrial biopsy immediately due to elevated estradiol
Answer-: C
Explanation: Late menopausal transition (STRAW -1) with severe VMS. She is <60 and
within the window of opportunity. Transdermal route preferred in smokers and
overweight patients (lower VTE/TG risk). Elevated estradiol is classic for LOOP events
in late transition; biopsy not indicated without abnormal bleeding. NAMS 2022 strongly
supports systemic HT as first-line for bothersome VMS in appropriate candidates.
Question 202
A 52-year-old woman underwent TAH-BSO for endometriosis 3 months ago. She now
has 20–30 severe hot flashes daily and insomnia. She has no contraindications to HT.
Which regimen provides the highest likelihood of symptom relief and long-term
bone/CV protection per NAMS?
A. Conjugated estrogens 0.45 mg + MPA 2.5 mg daily
B. Transdermal estradiol 0.05–0.1 mg/day (titrate to symptoms)
C. Oral estradiol 1 mg + norethindrone acetate 0.5 mg
D. Estradiol patch 0.05 mg twice weekly + micronized progesterone 200 mg days 1–12
monthly
E. Low-dose vaginal estradiol ring only
Answer-: B
Explanation: Surgical menopause = abrupt, severe estrogen withdrawal. NAMS
recommends systemic estrogen alone (no progestogen needed post-hysterectomy) until
,at least age 52 (average natural menopause). Transdermal avoids first-pass hepatic
effect and has the most favorable risk profile in surgical menopause.
Question 203
A 58-year-old woman, 7 years postmenopausal, presents with recurrent UTI (4 culture-
proven in past year) and new dyspareunia. Exam: pale, friable vaginal mucosa, pH 6.8.
She has no abnormal bleeding. Breast cancer history 8 years ago (ER+, treated with
mastectomy + tamoxifen ×5 years, now off all therapy). Which is the most appropriate
management?
A. Intravaginal DHEA (prasterone) 6.5 mg nightly
B. Systemic HT with CEE + bazedoxifene
C. Ospemifene 60 mg daily
D. Low-dose vaginal estradiol cream 0.5 g twice weekly
E. Fractional CO₂ laser therapy ×3 sessions
Answer-: A
Explanation: History of ER+ breast cancer = systemic HT and SERMs (ospemifene,
bazedoxifene) contraindicated or controversial. Low-dose vaginal estradiol has minimal
systemic absorption but many oncologists still prefer to avoid any estrogen. Prasterone
(DHEA) is FDA-approved for GSM, converts locally to estrogen/androgen, and has the
most favorable safety profile in breast-cancer survivors per 2022 NAMS and ASCO
guidelines.
Question 204
According to the 2022 NAMS Hormone Therapy Position Statement, which absolute
risk increase for breast cancer is correct for combined estrogen-progestogen therapy
used >5 years starting at age 52?
A. 0 additional cases per 1,000 women
B. <1 additional case per 1,000 women-years
C. 4–6 additional cases per 1,000 women over 5 years
D. 8–10 additional cases per 1,000 women over 5 years
E. >20 additional cases per 1,000 women
Answer-: C
Explanation: WHI long-term follow-up and meta-analyses cited by NAMS: combined
EPT started <60 years increases breast cancer risk by approximately 4–6 additional
, cases per 1,000 women over 5 years of use (roughly +1 per 1,000 woman-years).
Estrogen-only therapy shows no increase or slight decrease.
Question 205
A 62-year-old woman (12 years post-FMP) with osteoporosis (T-score –2.8 spine) and
severe VMS asks about HT. She has no contraindications. What is the most appropriate
recommendation?
A. Start transdermal estradiol + micronized progesterone; HT is first-line for
osteoporosis
B. HT is no longer indicated for bone protection at her age; start denosumab or
zoledronic acid
C. Offer HT for VMS but add alendronate for bone because HT benefit uncertain >10
years postmenopause
D. HT contraindicated due to age >60
E. Use raloxifene for both VMS and bone
Answer-: B
Explanation: NAMS 2022: HT is FDA-approved for prevention but not treatment of
postmenopausal osteoporosis. After age 60 or >10 years post-FMP, risks generally
outweigh benefits for bone alone. Treat osteoporosis with proven agents
(bisphosphonates, denosumab, anabolic agents). HT can still be considered for severe
VMS if patient accepts risk.
A 55-year-old woman, 4 years postmenopausal, presents complaining only of vaginal
dryness and pain with intercourse twice weekly. She has no vasomotor symptoms, no
bleeding, normal mammogram 4 months ago, and an intact uterus. Exam shows thin,
pale mucosa and vaginal pH 6.5. She specifically asks, “Do I still need a progestin if I
only want something in the vagina?” According to the 2022 NAMS Position Statement
on Hormone Therapy, what is the most appropriate response and management?
A. Yes – all postmenopausal women with a uterus require cyclic progestin even with
low-dose vaginal estrogen
B. No – low-dose vaginal estrogen (≤10 µg estradiol or estriol) does not require
endometrial opposition
C. Yes – start continuous micronized progesterone 100 mg daily for safety
D. No – but switch to ospemifene because it is completely non-hormonal
E. Yes – insert a levonorgestrel IUD before starting vaginal estrogen
