Download NAMS Menopause Certification Exam Study Set Questions with Correct Answers 2025 Updates and more Exams Nursing in PDF only on Docsity!
NAMS Menopause Certification Exam Study Set
Questions with Correct Answers 2025- 2026
Update Highly Rated (Score A)
timing hypothesis Women 50-59 has lower all cause mortality and fewer MIs in WHI than women age > % of women who will experience sx. recurrence if HT is stopped? 50% Tamoxifen (SERM) —Potent antiestrogen in breast tissue —Can reduce the risk of invasive ER+ breast cancer in high-risk womenby 49% —Estrogen agonist on bone, liver, and uterus Raloxifene (SERM) —Second-generation SERM
—Estrogen agonist on bone —Minimal effect on uterine endometrium —Antiestrogenic effects on breast —Lower risk of uterine cancer, VTE, and cataracts compared with tamoxifen Ospemifene (SERM) —Estrogen agonist on vaginal tissue & bone —FDA approved for treatment of moderate to severe dyspareunia —Modest increase in hot flashes compared with placebo (9.6% vs 3.4%) —Estrogenic-type response on endometrium but was not associated with increase in hyperplasia or endometrial cancer within first year —Associated with slight increased risk of hemorrhagic stroke and VTE (black box warning) Bazedoxifene (SERM) —Third-generation SERM —Estrogen agonist on bone —Estrogen antagonist on breast and endometrial tissue —Approved in Europe and Japan for treatment of osteoporosis —Bazedoxifene and CEE (Duavee) combination is available in the United States for treatment of VMS and prevention of osteoporosis
1 dose of PCV PNA vaccine recommendation: Patient age >65 who's previously received PPSV23 vaccine age 65: 1 dose of PCV or 1 dose of PCV PNA vaccine recommendation: Patient age >65 who previously received both PCV13 and PPSV23 under the age of 65, but no vaccination was received at age > age >65: 1 dose of PPSV or 1 dose of PCV PNA vaccine recommendation: Patient age 19-64 with clinical risk factors what are the risk factors?
1 dose of PCV15 --> 1 dose of PPSV23 (1 yr later) or 1 dose of PCV20 only RFs include: DM, asthma/COPD/lung disease, smoking, heart disease, liver disease/alcoholism, CKD, cochlear implant, asplenia, CSF leak, malignancy, HIV/immunodeficiencies, organ transplant, or sickle cell. what day of cycle to draw FSH to predict ovarian response/reserve? day 3 normal day 3 FSH? FSH value for menopause? < 10
of ultrasound detected follicles 2-10 mm in size
AFC (antral follicle count)
post: higher consequence of inhibin B and AMH drop in early menopause transition? FSH spikes --> fast growth of remaining follicles (twins more likely) --> shorter follicular phase --> follicle atresia --> LOOP cycles --> pronounced PMS sx from longer luteal phase --> cycle irregularity by >7 days dec ovarian reserve causes the drop in what 2 hormones? inhibin B and AMH 4 adrenal androgens —Dehydroepiandrosterone (DHEA) —Dehydroepiandrosterone sulfate (DHEAS) —Androstenedione —Testosterone where are adrenal androgens converted to estrogen? peripheral tissue
what happens to DHEA levels during menopause transition? transient increase then return to premenopause baseline is DHEA supplementation in menopause recommended? no (Systematic review and meta-analysis of DHEA use in postmenopausal women with normal adrenal function found no evidence of improvement in sexual symptoms, serum lipids, serum glucose, weight, or bone mineral density) dx of POI? amenorrhea >4 mo in age <4 0 FSH >25 on 2 occasions 4 etiologies of POI most common? (1) Genetic (turner, fragile X) (2) Autoimmune (adrenal Ab/Addison's) (3) Cancer (chemo, radiation, surgical oophrectomy) (4) Idiopathic --> most common
1.25 mg conjugated equine estrogens (CEE) 2 mg of estradiol PO progestin therapy for POI If uterus is present, cyclical progestins should be added ≥12 d/mo estrogen maintains what pH in the vagina? acidic, 3.8 - 4. high BMI associated with (increase/decrease) in severity of VMS in menopause transition increase % skin collagen loss in 1st 5 yrs after menopause 30% (2% per yr decline over next 20 yrs) 2 most common causes of hair loss in menopause transition
Female pattern hair loss (FPHL; thinning on crown) and telogen effluvium (sudden onset of hair shedding, stress-induced) tx of FPHL topical minoxidil (FDA-approved) spiro/finasteride (off label) median duration of VMS 7 - 10 yrs ethnic group with most VMS? ethnic group with least VMS? black japanese RFs for VMS •Low socioeconomic status •Low educational attainment
Off-label non-hormonal tx for VMS SSRIs SNRIs Gabapentin Clonidine Oxybutynin which vaginal lesions should be biopsied? white, pigmented, or thickened lesions other populations who get GSM (ie: other prolonged low estrogen states) prolonged lactation hypothalamic amenorrhea POI Chemo/radiation GnRH agonists Aromatase inhibitors Non-hormonal GSM treatment
when to use? vaginal lubricants/moisturizers, topical lido mild/mod GSM, use 1st line (test answer) hormonal options for GSM when to use? vaginal ET vaginal DHEA systemic ET (with VMS) mod to severe GSM, use 2nd line, not studied in breast CA/avoid if able (test answer) oral option for GSM ospemifene antagonist at breast, however, don't use in breast CA (not studied) ospemifene:
1 vaginal ring for GSM only estradiol (Estring) note: estradiol (Femring) given local + systemic estrogen, must use progesterone highest estradiol option out of GSM treatments? avg serum estradiol level with this? Estring, 8 pg/mL others: 3-4 pg/mL (below normal postmeno ranges) Progesterone needed with local GSM therapies? Generally no -- estradiol never above 10 consider if pt has other RFs for endometrial CA which vaginal lesion? vulva, itchy, white lichen sclerosis
which vaginal lesion? vagina, burning, red lichen planus tx for both lichen sclerosis & lichen planus high-potency topical steroids, ointments preferred to creams (ex: Clobetasol ointment 0.05%, betamethasone ointment 0.05%) 4 Vulvovaginal neoplasias (1) vulval intraepithelial neoplasia (VIN) (2) squamous cell carcinoma (3) basal cell carcinoma (4) Paget disease undifferentiated VIN (uVIN) HPV-related? lichen sclerosis/planus related?
which 3 common drugs? Hyperthyroidism, hyperparathyroidism, hypercalciuria, certain drugs (eg: tamoxifen, steroids, PPIs), calcium/vitamin D deficiency, RA, celiac disease, malabsorptive diseases such as Crohn disease, and ulcerative colitis Median age of menopause in US women 52.54 y POI Intermittent ovarian function & insufficient estrogen levels occurring at age <40 y which STRAW stage? menarche / early reproductive
- 5 which STRAW stage? peak reproductive
which STRAW stage? late reproductive
- 3 which STRAW stage? perimenopause
- 2 to - 1 & +1a which STRAW stage? FMP & 12 months after final menstrual period FMP = 0 12 months after = +1a which STRAW stage?
