NAMS Menopause Textbook – Chapter 3 Vasomotor Symptoms – Exam Questions & Correct Answers

This document contains exam questions and verified answers based on the NAMS (North American Menopause Society) Menopause Textbook, with special focus on Chapter 3 (Vasomotor Symptoms) plus combined chapters. Topics include prevalence of VMS (60-80%), sociodemographic factors (Black women, low SES most affected), duration of moderate-to-severe VMS (7-10 years, 4.5 years after FMP), relationship between adiposity and VMS (early transition: higher adiposity = increased VMS; later/postmenopause: higher adiposity = fewer VMS), smoking doubles VMS risk, hysterectomy with ovarian retention increases VMS risk, pathophysiology of VMS (central origin – alterations in hypothalamic thermoregulation, increased GnRH, increased neurokinin B gene expression from estrogen withdrawal), hot flashes vs. night sweats, severity classification (mild: heat without sweating; moderate: heat with sweating, able to continue activity; severe: heat with sweating causing cessation of activity), thermoregulation hypothesis (narrowed thermoneutral zone), neurotransmitters involved (serotonin, norepinephrine), first-line FDA-approved therapy for VMS (HT: ET alone for no uterus, EPT or ET + bazedoxifene for uterus), estradiol vs. CEE efficacy (no difference for VMS, but estradiol more effective for anxiety/depression), ET/EPT reduces VMS frequency by 75%, time to relief (6+ weeks), 50% experience symptom return after discontinuing HT, only FDA-approved non-hormonal medication (paroxetine – Brisdelle 10-25 mg daily), other SSRIs/SNRIs effective (citalopram, escitalopram, desvenlafaxine, venlafaxine), gabapentin (600-2400 mg/day), clonidine (less effective, AEs: rebound hypertension, hypotension, dry mouth), oxybutynin (15 mg effective for VMS, AE dry mouth), neurokinin B antagonists (under investigation), CBT and clinical hypnosis effective, alternatives not shown helpful (mindfulness, weight loss, physical activity/yoga, paced respiration, acupuncture, S-equol, OTC botanicals including black cohosh), stellate ganglion block under investigation, calcium and vitamin D recommendations postmenopause (calcium 1,200 mg/day, vitamin D 800-1,000 IU/day), bio-identical hormones (estrone, estriol, 17-beta estradiol, micronized progesterone), FRAX score thresholds for medication therapy (hip fracture ≥3% or major osteoporotic fracture ≥20%), DXA repeat every 2 years on osteoporosis medication, osteoporosis medication options (bisphosphonates, zoledronic acid, calcitonin, estrogen, raloxifene, terip