What are the key concepts to study for the North American Menopause Society (NAMS) certification exam?

From the Guidelines

To prepare for the menopause society test, focus on key areas including hormonal physiology, symptom management, and treatment options, as these are crucial for reducing morbidity, mortality, and improving quality of life in menopausal women. When studying, prioritize the most recent and highest quality evidence, such as the systematic review by the U.S. Preventive Services Task Force 1, which updates recommendations on menopausal hormone therapy for the primary prevention of chronic conditions. Key areas to study include:

• Hormonal physiology, specifically the hypothalamic-pituitary-gonadal axis and the effects of declining estrogen levels on multiple body systems
• Symptom management, including vasomotor symptoms (hot flashes, night sweats) and their treatment with hormonal and non-hormonal options like estrogen therapy, SSRIs/SNRIs (paroxetine, venlafaxine), gabapentin, and clonidine
• Treatment options, such as hormone therapy regimens, including estrogen-only therapy (0.3-1.0 mg oral estradiol daily or 0.025-0.1 mg transdermal patches) for hysterectomized women and combined estrogen-progestogen therapy for women with intact uteri
• Genitourinary syndrome of menopause treatments, including local estrogen (10 mcg vaginal estradiol tablet, cream, or ring), DHEA (prasterone), and ospemifene
• Bone health management with calcium (1000-1200 mg daily), vitamin D (800-1000 IU daily), and osteoporosis medications
• Cardiovascular risk modifications, cognitive effects, and sexual health concerns It is also essential to create flashcards for terminology, diagnostic criteria, and treatment algorithms, and practice case-based scenarios applying knowledge to clinical situations, as the exam likely includes application questions rather than just memorization, as noted in the systematic review 1.

From the FDA Drug Label

The WHI estrogen plus progestin substudy was stopped early. According to the predefined stopping rule, after an average follow-up of 5.6 years of treatment, the increased risk of breast cancer and cardiovascular events exceeded the specified benefits included in the “global index. ” The absolute excess risk of events in the “global index” was 19 per 10,000 women-years. For those outcomes included in the WHI “global index” that reached statistical significance after 5. 6 years of follow-up, the absolute excess risks per 10,000 women-years in the group treated with CE plus MPA were 7 more CHD events, 8 more strokes, 10 more PEs, and 8 more invasive breast cancers, while the absolute risk reductions per 10,000 women-years were 6 fewer colorectal cancers and 5 fewer hip fractures

The FDA drug label does not answer the question.

From the Research

Menopause Society Test Study Questions

To adequately prepare for the menopause society test, consider the following study questions:

• What are the typical age ranges for menopause, and what are the common symptoms experienced by women during this transition? 2
• What are the efficacious treatments for women with bothersome vasomotor symptoms or genitourinary syndrome of menopause (GSM) symptoms, and what are their associated risks and benefits? 2, 3
• How do selective estrogen receptor modulators (SERMs) work, and what are their clinical applications in the treatment of menopausal symptoms, osteoporosis, and breast cancer? 3, 4
• What are the current recommendations for hormone replacement therapy (HRT) use in menopausal women, and what are the potential risks and benefits associated with HRT? 5, 6
• How can menopausal women at high risk for breast cancer be identified and managed, and what treatment options are available for them? 6

Key Concepts to Focus On

Some key concepts to focus on when studying for the menopause society test include:

• The pathophysiology of menopause and its associated symptoms
• The different treatment options available for menopausal symptoms, including hormonal and nonhormonal therapies
• The risks and benefits associated with each treatment option, including the potential impact on breast cancer risk and cardiovascular health
• The role of SERMs in the treatment of menopausal symptoms and breast cancer
• The current recommendations for HRT use in menopausal women and the potential risks and benefits associated with HRT

Treatment Options

Treatment options for menopausal symptoms include:

• Hormonal therapies, such as systemic estrogen alone or combined with a progestogen
• Nonhormonal therapies, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
• SERMs, such as tamoxifen, raloxifene, and bazedoxifene
• Tissue selective estrogen complex (TSEC) therapy, which combines a SERM with an estrogen to achieve a favorable clinical profile 3