The NAMS Certified Menopause Practitioner (NCMP) Exam
Prep 2026–2027: A 100-Question Practice Exam with
Evidence-Based Rationales
Exam Structure
Domain % of Exam Questions
Vasomotor Symptoms (VMS) & Non-Hormonal Rx 20% 20
Hormone Therapy (HT): Indications, Regimens, Safety 25% 25
Genitourinary Syndrome of Menopause (GSM) 15% 15
Bone Health & Osteoporosis 10% 10
Cardiovascular & Metabolic Effects 10% 10
Breast Cancer Risk & Survivorship 8% 8
Perimenopause & POI (Premature Ovarian Insufficiency) 7% 7
Sexual Health, Mood, Sleep, Cognition 5% 5
Total 100% 100
PART 1: VASOMOTOR SYMPTOMS (VMS) & NON-HORMONAL THERAPY
(Questions 1–20)
Q1. A 55-year-old woman with a history of ER+ breast cancer (5 years ago,
currently on anastrozole) has 10–12 moderate hot flashes/day. Which is the most
effective FDA-approved non-hormonal option?
A) Gabapentin 300 mg three times daily
B) Venlafaxine 75 mg daily
C) Paroxetine 7.5 mg daily
D) Oxybutynin 5 mg twice daily
1|Page
,Correct Answer: C
Rationale: Low-dose paroxetine 7.5 mg (Brisdelle) is the only non-hormonal agent
FDA-approved specifically for moderate-to-severe VMS. It is a strong CYP2D6
inhibitor but this patient is on anastrozole (not tamoxifen), so no drug interaction.
Venlafaxine and gabapentin are effective but off-label. Oxybutynin has limited
data.
Q2. A 62-year-old with prior unprovoked VTE (3 years ago) requests treatment for
8 severe night sweats nightly. Which is safest?
A) Transdermal estradiol 0.05 mg + oral micronized progesterone
B) Oral conjugated equine estrogen 0.3 mg daily
C) Fezolinetant 45 mg daily
D) Compounded bioidentical estriol cream
Correct Answer: C
Rationale: Fezolinetant (Veozah) is an NK3 receptor antagonist, non-hormonal,
FDA-approved for moderate-severe VMS, with no VTE risk. VTE history is a
contraindication to all systemic hormone therapy, including transdermal (lower
risk but not zero). Compounded hormones are unregulated and not safer.
Q3. Which lifestyle or behavioral intervention has Level I evidence for reducing
VMS bother?
A) Soy isoflavones 150 mg/day
B) Cognitive behavioral therapy (CBT)
C) Acupuncture weekly
D) Vitamin E 800 IU/day
Correct Answer: B
Rationale: CBT has consistent RCT evidence showing reduction in VMS bother
(though less effect on frequency). Isoflavones show modest, inconsistent effects.
Acupuncture may help via placebo. Vitamin E has minimal benefit in controlled
trials.
2|Page
,Q4. A 49-year-old perimenopausal woman with no contraindications requests
hormone therapy for hot flashes. She has a uterus. Which regimen is first-line?
A) Oral estradiol 1 mg + medroxyprogesterone acetate 2.5 mg continuous
B) Transdermal estradiol 0.05 mg patch + oral micronized progesterone 200 mg x
12 days/month
C) Oral conjugated equine estrogen 0.625 mg alone
D) Transdermal estradiol 0.1 mg patch alone
Correct Answer: B
Rationale: Transdermal estradiol avoids first-pass hepatic metabolism, lowering
VTE risk. Cyclic oral micronized progesterone provides endometrial protection
with a better metabolic profile than MPA. Option A is acceptable but transdermal
preferred in perimenopause if VTE risk factors present. Option C and D lack
progesterone in a woman with a uterus.
Q5. A 53-year-old woman with major depressive disorder (well-controlled on
escitalopram) has 6 hot flashes/day. She does not want hormones. Which non-
hormonal agent is preferred?
A) Paroxetine 7.5 mg
B) Venlafaxine XR 75 mg
C) Gabapentin 300 mg at bedtime
D) Clonidine 0.1 mg patch weekly
Correct Answer: B
Rationale: Venlafaxine has dual benefit: treats VMS and supports mood.
Paroxetine 7.5 mg adds another SSRI to escitalopram (risk of serotonin syndrome,
no added mood benefit). Gabapentin causes sedation. Clonidine has modest
efficacy. Guideline: switch SSRI to venlafaxine if VMS + depression; but if
depression is controlled, adding venlafaxine off-label is still reasonable.
Q6. What is the mechanism of action of fezolinetant?
A) Selective serotonin reuptake inhibition
B) Neurokinin-3 receptor antagonism in the hypothalamus
3|Page
, C) Alpha-2 adrenergic agonism
D) GABA receptor modulation
Correct Answer: B
Rationale: Fezolinetant blocks neurokinin-3 (NK3) receptors in the hypothalamic
thermoregulatory center, reducing the frequency and severity of VMS. This is a
novel non-hormonal pathway distinct from SSRIs, gabapentin, or clonidine.
Q7. A 58-year-old woman with obesity (BMI 38), hypertension, and diabetes has 8
hot flashes/day. She has a history of provoked DVT (post-surgery 10 years ago).
Which therapy is most appropriate?
A) Oral estradiol + progesterone
B) Transdermal estradiol + micronized progesterone
C) Fezolinetant
D) Venlafaxine
Correct Answer: C
Rationale: Even provoked VTE is a relative contraindication to HT; transdermal HT
may be considered but fezolinetant eliminates VTE risk entirely. Venlafaxine is
second-line. Given her metabolic syndrome, avoiding oral HT is important, but
fezolinetant is safest.
Q8. Which of the following is a common adverse effect of gabapentin for VMS?
A) Weight gain
B) Dry mouth and constipation
C) Drowsiness and dizziness
D) Hypertension
Correct Answer: C
Rationale: Gabapentin causes dose-dependent CNS effects including somnolence,
dizziness, and ataxia. Weight gain occurs but is less common. Dry mouth is mild.
Hypertension is not typical.
4|Page
Prep 2026–2027: A 100-Question Practice Exam with
Evidence-Based Rationales
Exam Structure
Domain % of Exam Questions
Vasomotor Symptoms (VMS) & Non-Hormonal Rx 20% 20
Hormone Therapy (HT): Indications, Regimens, Safety 25% 25
Genitourinary Syndrome of Menopause (GSM) 15% 15
Bone Health & Osteoporosis 10% 10
Cardiovascular & Metabolic Effects 10% 10
Breast Cancer Risk & Survivorship 8% 8
Perimenopause & POI (Premature Ovarian Insufficiency) 7% 7
Sexual Health, Mood, Sleep, Cognition 5% 5
Total 100% 100
PART 1: VASOMOTOR SYMPTOMS (VMS) & NON-HORMONAL THERAPY
(Questions 1–20)
Q1. A 55-year-old woman with a history of ER+ breast cancer (5 years ago,
currently on anastrozole) has 10–12 moderate hot flashes/day. Which is the most
effective FDA-approved non-hormonal option?
A) Gabapentin 300 mg three times daily
B) Venlafaxine 75 mg daily
C) Paroxetine 7.5 mg daily
D) Oxybutynin 5 mg twice daily
1|Page
,Correct Answer: C
Rationale: Low-dose paroxetine 7.5 mg (Brisdelle) is the only non-hormonal agent
FDA-approved specifically for moderate-to-severe VMS. It is a strong CYP2D6
inhibitor but this patient is on anastrozole (not tamoxifen), so no drug interaction.
Venlafaxine and gabapentin are effective but off-label. Oxybutynin has limited
data.
Q2. A 62-year-old with prior unprovoked VTE (3 years ago) requests treatment for
8 severe night sweats nightly. Which is safest?
A) Transdermal estradiol 0.05 mg + oral micronized progesterone
B) Oral conjugated equine estrogen 0.3 mg daily
C) Fezolinetant 45 mg daily
D) Compounded bioidentical estriol cream
Correct Answer: C
Rationale: Fezolinetant (Veozah) is an NK3 receptor antagonist, non-hormonal,
FDA-approved for moderate-severe VMS, with no VTE risk. VTE history is a
contraindication to all systemic hormone therapy, including transdermal (lower
risk but not zero). Compounded hormones are unregulated and not safer.
Q3. Which lifestyle or behavioral intervention has Level I evidence for reducing
VMS bother?
A) Soy isoflavones 150 mg/day
B) Cognitive behavioral therapy (CBT)
C) Acupuncture weekly
D) Vitamin E 800 IU/day
Correct Answer: B
Rationale: CBT has consistent RCT evidence showing reduction in VMS bother
(though less effect on frequency). Isoflavones show modest, inconsistent effects.
Acupuncture may help via placebo. Vitamin E has minimal benefit in controlled
trials.
2|Page
,Q4. A 49-year-old perimenopausal woman with no contraindications requests
hormone therapy for hot flashes. She has a uterus. Which regimen is first-line?
A) Oral estradiol 1 mg + medroxyprogesterone acetate 2.5 mg continuous
B) Transdermal estradiol 0.05 mg patch + oral micronized progesterone 200 mg x
12 days/month
C) Oral conjugated equine estrogen 0.625 mg alone
D) Transdermal estradiol 0.1 mg patch alone
Correct Answer: B
Rationale: Transdermal estradiol avoids first-pass hepatic metabolism, lowering
VTE risk. Cyclic oral micronized progesterone provides endometrial protection
with a better metabolic profile than MPA. Option A is acceptable but transdermal
preferred in perimenopause if VTE risk factors present. Option C and D lack
progesterone in a woman with a uterus.
Q5. A 53-year-old woman with major depressive disorder (well-controlled on
escitalopram) has 6 hot flashes/day. She does not want hormones. Which non-
hormonal agent is preferred?
A) Paroxetine 7.5 mg
B) Venlafaxine XR 75 mg
C) Gabapentin 300 mg at bedtime
D) Clonidine 0.1 mg patch weekly
Correct Answer: B
Rationale: Venlafaxine has dual benefit: treats VMS and supports mood.
Paroxetine 7.5 mg adds another SSRI to escitalopram (risk of serotonin syndrome,
no added mood benefit). Gabapentin causes sedation. Clonidine has modest
efficacy. Guideline: switch SSRI to venlafaxine if VMS + depression; but if
depression is controlled, adding venlafaxine off-label is still reasonable.
Q6. What is the mechanism of action of fezolinetant?
A) Selective serotonin reuptake inhibition
B) Neurokinin-3 receptor antagonism in the hypothalamus
3|Page
, C) Alpha-2 adrenergic agonism
D) GABA receptor modulation
Correct Answer: B
Rationale: Fezolinetant blocks neurokinin-3 (NK3) receptors in the hypothalamic
thermoregulatory center, reducing the frequency and severity of VMS. This is a
novel non-hormonal pathway distinct from SSRIs, gabapentin, or clonidine.
Q7. A 58-year-old woman with obesity (BMI 38), hypertension, and diabetes has 8
hot flashes/day. She has a history of provoked DVT (post-surgery 10 years ago).
Which therapy is most appropriate?
A) Oral estradiol + progesterone
B) Transdermal estradiol + micronized progesterone
C) Fezolinetant
D) Venlafaxine
Correct Answer: C
Rationale: Even provoked VTE is a relative contraindication to HT; transdermal HT
may be considered but fezolinetant eliminates VTE risk entirely. Venlafaxine is
second-line. Given her metabolic syndrome, avoiding oral HT is important, but
fezolinetant is safest.
Q8. Which of the following is a common adverse effect of gabapentin for VMS?
A) Weight gain
B) Dry mouth and constipation
C) Drowsiness and dizziness
D) Hypertension
Correct Answer: C
Rationale: Gabapentin causes dose-dependent CNS effects including somnolence,
dizziness, and ataxia. Weight gain occurs but is less common. Dry mouth is mild.
Hypertension is not typical.
4|Page
