NAMS Menopause Certification | Questions and Answers | 2026 Update | Exam Review Pack

NAMS Menopause Certification |
Questions and Answers | 2026 Update |
Exam Review Pack




DOMAIN 1: PHYSIOLOGY AND PATHOPHYSIOLOGY OF THE
MENOPAUSE TRANSITION (≈99% of exam)

Question 1
What is the “climacteric phase”?
A) The final menstrual period
B) The period of endocrinologic, somatic, and transitory psychologic changes
around the time of menopause
C) The perimenopause only
D) The postmenopausal period

✅ Correct Answer: B

Rationale: The climacteric phase is the period of endocrinologic, somatic, and
transitory psychologic changes that occur around the time of menopause. It
encompasses the transition from the reproductive stage to the non-reproductive
stage. The final menstrual period (A) defines menopause itself, not the climacteric .

,Question 2
What is the definition of “early menopause”?
A) LMP before age 40
B) LMP before age 45
C) LMP before age 50
D) LMP after age 55

✅ Correct Answer: B

Rationale: Early menopause is defined as the last menstrual period (LMP)
occurring before age 45. It should be distinguished from primary ovarian
insufficiency (POI), which occurs before age 40. Late menopause is defined as
LMP after age 54 .




Question 3
What term describes menopause that occurs before age 40?
A) Early menopause
B) Premature ovarian insufficiency (POI)
C) Late menopause
D) Premenopause

✅ Correct Answer: B

Rationale: Primary ovarian insufficiency (POI) is defined as the loss of ovarian
function before the age of 40. It is distinguished from early menopause, which
occurs between ages 40 and 45. Women with POI require hormone therapy until at
least age 50 for bone and cardiovascular protection .

,Question 4
According to the STRAW+10 staging system, what characterizes “early
menopause transition” (stage –2)?
A) 60 or more consecutive days of amenorrhea
B) Persistent difference of 7 days or more in the length of consecutive cycles
C) Heavy menstrual bleeding
D) Regular cycles 26–35 days

✅ Correct Answer: B

Rationale: Stage –2 (early menopause transition) is marked by persistent
difference of ≥7 days in the length of consecutive cycles and is when cycle
irregularity begins. Stage –1 (late transition) is defined by ≥60 days of
amenorrhea .




Question 5
What characterizes “late menopause transition” (stage –1) according to
STRAW+10?
A) Persistent difference of 7 days or more in cycle length
B) 60 or more consecutive days of amenorrhea
C) Regular cycles with elevated FSH
D) Complete cessation of menses

✅ Correct Answer: B

Rationale: Stage –1 (late menopause transition) is defined by ≥60 consecutive
days of amenorrhea. This stage precedes the final menstrual period (FMP) and is
associated with more pronounced menopausal symptoms .

, Question 6
What does the luteal out-of-phase (LOOP) event explain?
A) Elevated FSH in early menopause
B) Elevated estrogen levels in some perimenopausal women
C) Low progesterone in perimenopause
D) Androgen excess in menopause

✅ Correct Answer: B

Rationale: The LOOP event explains why some perimenopausal women have
elevated estrogen levels. In the early menopause transition, elevated FSH levels are
adequate to recruit a second follicle, which results in a follicular phase-like rise in
estradiol secretion superimposed on the mid-to-late luteal phase of the ongoing
ovulatory cycle .




Question 7
What is the mean age of natural menopause in the United States?
A) 45 years
B) 51 years
C) 55 years
D) 48 years

✅ Correct Answer: B

Rationale: The mean age of natural menopause in the United States is
approximately 51 years. Age 45 is considered early menopause, while age 55 or
later is considered late menopause .