NAMS MENOPAUSE CERTIFICATION
COMPREHENSIVE STUDY GUIDE 2026
FULL QUESTIONS AND SOLUTIONS
GRADED A+
◍ FOD treatments.
Answer: Directed masturbation is the most researched behavioral treatment.
◍ Percentage of US women acquiring genital HPV by age 50.
Answer: 80%
◍ LOOP Cycles.
Answer: Explains elevation of Estradiol in perimenopause- Rising FSH
levels recruit 2nd follicle during luteal phase which leads to overproduction
of Estradiol - This causes menstrual changes in future cycles
◍ Start Teriparatide, Osteoanabolic agent if:.
Answer: - Recent fracture (within 1-2 years)- BMD less than -3.0- FRAX
>30% MOF- FRAX 4.5% hip fracture
◍ Cognitive Effects of HRT.
Answer: Small or no overall effect on cognition.
◍ Early Menopause Transition (-2).
Answer: 7 or more days persistent difference in cycle length from previous
normal cycle - Results of increased follicular aging and depletion - Inhibin
B decreases- FSH increases (Variable)
◍ Cortisol levels and VMS severity.
Answer: Cortisol levels have NOT been associated with more severe VMS.
◍ Contraindications to HRT.
, Answer: History of endometrial cancer, personal history of breast cancer,
history of thromboembolic disorders, acute or chronic liver disease,
coronary artery disease, elevated triglycerides, undiagnosed vaginal
bleeding.
◍ Location of estrogen receptors.
Answer: Vagina, vulva, urethra, trigone of the bladder.
◍ Bone loss by age 80.
Answer: 30%
◍ Screening tool for intimate partner violence.
Answer: HARK
◍ Theories about etiology of hot flashes (6).
Answer: Lower ovarian estradiol thermoregulation zone is narrowed
neurokinins-regulate GnRH secretion. KNDy new meds serotonin cortisol
and HPI axis dysregulation endothelial dysfunction.
◍ Driving piece of menopause is ovarian follicles depleting. What does this do
to the inhibin B and AMH?.
Answer: Inhibin and AMH decrease.
◍ Driving piece of menopause is ovarian follicles depleting..
Answer: What does this do to the inhibin B and AMH? Inhibin and AMH
decrease.
◍ Anovulatory Bleeding.
Answer: Presents as noncyclic menstrual blood flow ranging from spotting
to heavy
◍ FRAX score.
Answer: Used to predict the 10 year risk of fracture; Elements include Age -
40-90, Gender, BMI, Previous fracture, Previous hip fracture, Current
smoking, Glucocorticoid use (3 months at more than 5mg/day), Rheumatoid
arthritis, Secondary osteoporosis, EtOH - more than 3 drinks a day, Bone
mineral density
, ◍ Headaches and HT.
Answer: - Increase risk of stroke in women who take COC who have
migraine with aura - No contraindication has not been identified for this
with migraine who need HT doses for treatment of symptoms of menopause
and/or their HA
◍ Implications of estrogen drop on skin during menopause.
Answer: Decreased fibroblast activity, disrupted elastin, decreased GAG
production, disrupted melanocyte regulation, decreased blood flow and
cellular oxygenation effects on keratinocytes, disruption of cellular growth
factors and repair enzymes, accelerated lipoatrophy, fat pad modification,
bone resorption.
◍ Bisphosphonates and BMD testing.
Answer: - Repeat BMD after 5 years of treatment to determine if therapy
can be discontinued - Monitor renal function
◍ HT and weight.
Answer: - No effect on weight - May result in favorable body fat distribution
◍ Testosterone estrogen level trend in menopause.
Answer: Testosterone levels decrease but not as significantly as estrogen
levels therefore leading to a hypoestrogenemic and relative hyperandrogenic
state that may lead to patterned hair loss
◍ Physiologic vs continuous hormonal contraception.
Answer: Physiologic is better than continuous hormonal contraception.
◍ Hot Flashes.
Answer: Median duration of 10 years in menopause.
◍ Paroxetine.
Answer: Only non-hormone medication FDA approved for VMS
◍ High risk HPV types.
Answer: 16 and 18.
◍ Definition of osteoporosis.
COMPREHENSIVE STUDY GUIDE 2026
FULL QUESTIONS AND SOLUTIONS
GRADED A+
◍ FOD treatments.
Answer: Directed masturbation is the most researched behavioral treatment.
◍ Percentage of US women acquiring genital HPV by age 50.
Answer: 80%
◍ LOOP Cycles.
Answer: Explains elevation of Estradiol in perimenopause- Rising FSH
levels recruit 2nd follicle during luteal phase which leads to overproduction
of Estradiol - This causes menstrual changes in future cycles
◍ Start Teriparatide, Osteoanabolic agent if:.
Answer: - Recent fracture (within 1-2 years)- BMD less than -3.0- FRAX
>30% MOF- FRAX 4.5% hip fracture
◍ Cognitive Effects of HRT.
Answer: Small or no overall effect on cognition.
◍ Early Menopause Transition (-2).
Answer: 7 or more days persistent difference in cycle length from previous
normal cycle - Results of increased follicular aging and depletion - Inhibin
B decreases- FSH increases (Variable)
◍ Cortisol levels and VMS severity.
Answer: Cortisol levels have NOT been associated with more severe VMS.
◍ Contraindications to HRT.
, Answer: History of endometrial cancer, personal history of breast cancer,
history of thromboembolic disorders, acute or chronic liver disease,
coronary artery disease, elevated triglycerides, undiagnosed vaginal
bleeding.
◍ Location of estrogen receptors.
Answer: Vagina, vulva, urethra, trigone of the bladder.
◍ Bone loss by age 80.
Answer: 30%
◍ Screening tool for intimate partner violence.
Answer: HARK
◍ Theories about etiology of hot flashes (6).
Answer: Lower ovarian estradiol thermoregulation zone is narrowed
neurokinins-regulate GnRH secretion. KNDy new meds serotonin cortisol
and HPI axis dysregulation endothelial dysfunction.
◍ Driving piece of menopause is ovarian follicles depleting. What does this do
to the inhibin B and AMH?.
Answer: Inhibin and AMH decrease.
◍ Driving piece of menopause is ovarian follicles depleting..
Answer: What does this do to the inhibin B and AMH? Inhibin and AMH
decrease.
◍ Anovulatory Bleeding.
Answer: Presents as noncyclic menstrual blood flow ranging from spotting
to heavy
◍ FRAX score.
Answer: Used to predict the 10 year risk of fracture; Elements include Age -
40-90, Gender, BMI, Previous fracture, Previous hip fracture, Current
smoking, Glucocorticoid use (3 months at more than 5mg/day), Rheumatoid
arthritis, Secondary osteoporosis, EtOH - more than 3 drinks a day, Bone
mineral density
, ◍ Headaches and HT.
Answer: - Increase risk of stroke in women who take COC who have
migraine with aura - No contraindication has not been identified for this
with migraine who need HT doses for treatment of symptoms of menopause
and/or their HA
◍ Implications of estrogen drop on skin during menopause.
Answer: Decreased fibroblast activity, disrupted elastin, decreased GAG
production, disrupted melanocyte regulation, decreased blood flow and
cellular oxygenation effects on keratinocytes, disruption of cellular growth
factors and repair enzymes, accelerated lipoatrophy, fat pad modification,
bone resorption.
◍ Bisphosphonates and BMD testing.
Answer: - Repeat BMD after 5 years of treatment to determine if therapy
can be discontinued - Monitor renal function
◍ HT and weight.
Answer: - No effect on weight - May result in favorable body fat distribution
◍ Testosterone estrogen level trend in menopause.
Answer: Testosterone levels decrease but not as significantly as estrogen
levels therefore leading to a hypoestrogenemic and relative hyperandrogenic
state that may lead to patterned hair loss
◍ Physiologic vs continuous hormonal contraception.
Answer: Physiologic is better than continuous hormonal contraception.
◍ Hot Flashes.
Answer: Median duration of 10 years in menopause.
◍ Paroxetine.
Answer: Only non-hormone medication FDA approved for VMS
◍ High risk HPV types.
Answer: 16 and 18.
◍ Definition of osteoporosis.
