What Does It Take to Become a NAMS-Certified Menopause Practitioner?

In the world of menopause and perimenopause, women have few verified, well-informed allies on our side by name. My story of navigating the world of doctors was quite dramatic; in fact, I still can’t believe I survived it at times.

I saw nine or 10 doctors before I finally landed on the main one who provided most of the help I needed. These included multiple general medicine physicians, two psychiatrists (one of whom agreed the issue may have been perimenopause and encouraged me to pursue that lead), a psychologist (who told me it was probably perimenopause), two OB/GYNs (one told me I was too young for perimenopause and another prescribed me some highly ineffective birth control pills), a neurologist and, finally, my big win: a reproductive endocrinologist who was speaking my language, totally “got it” and did not hold back on prescribing hormone replacement therapy (HRT) for me.

The irony in this is that both OB/GYNs I saw were “Certified Menopause Practitioners” by the North American Menopause Society (NAMS). Physicians who earn this credential are referred to as NCMPs, or NAMS-Certified Menopause Practitioners. In fact, for this reason, I had sought out those particular doctors.

NAMS is akin to a nonprofit professional association of physicians in this specialty, but it is also a clearinghouse for health guidance and information related to menopausal and perimenopausal women, and our adjacent issues, and could also be considered as a semi think tank of sorts. From here stem multiple clinical recommendations and best practices that should inform the work of those who treat women at this stage of life.

Interestingly, the doctor who confirmed what was happening to me and that I was not crazy was not NAMS certified, though she dealt with women’s hormones and reproductive issues every day. Given that my experience with a NAMS-Certified Menopause Specialist was such a bust, I have wondered what it even takes to become one.

Is it a rigorous process? Do you have to prove and demonstrate your expertise in women’s midlife issues? How much do you need to know about prescribing, dosing and tweaking HRT? It is only for OB/GYNs, or can other doctors belong as well? This information is not easily findable, but here is what I have been able to determine.

What kind of doctors are NAMS doctors?
NAMS-certified clinicians are not necessarily of a particular discipline. Naturally, one might presume that NAMS-credentialed doctors are OB/GYNs, fertility specialists or hormone experts. But this is not true. Among those who qualify for the credential are nurses, nurse midwives, nurse practitioners, pharmacists, physicians and physician assistants. Aside from the credential, NAMS also has among its 2,000 members professionals who are pharmacists, nurses, anthropologists, psychologists, complementary / alternative medicine practitioners, OB/GYNs, internal medicine doctors and others.

Why would a doctor become NAMS-certified?
The reasons doctors may pursue NAMS certification is not necessarily about helping women lead better lives. Among the benefits NAMS touts for being certified are “possibility of more patient referrals, job promotion and higher salaries” as well as more industry credibility, legitimate logos for presentations and literature, media relations, permission to use the NCMP acronym professionally and a certificate for framing. Obviously, these perks are about the total value proposition and don’t necessarily mean those who seek NAMS certification don’t fundamentally care about their patients first. NAMS doctors are also featured in a special NAMS provider online directory, a precious resource for women seeking care for their perimenopausal and menopausal symptoms, and basically a pipeline for doctors’ ongoing self-directed patient referrals.

What are NAMS practitioners supposed to know?
The program objectives to be NAMS certified include being well-versed and authoritative on a number of things, including:

• menopause terminology
• endocrine and physical changes associated with reproductive and physiological aging
• risk factors related to lowered ovarian hormones
• performing a physical examination and conducting a health history
• selecting and interpreting appropriate laboratory and diagnostic tests
• describing current research on complementary and pharmacological treatments
• helping patients make informed decisions
• addressing psychosocial issues
• recognizing when referral to other services is appropriate and more

How hard is the test?
The NAMS test features 100 multiple-choice questions, with each question having three presented answer options (e.g. A, B or C). Once earned, NAMS certification is good for three years, but individuals must attain 45 credit hours of continuing medical education (CME) within that time frame. One representative sample question is:
Which of the following is a risk factor for postmenopausal osteoporosis?

1. Genetics
2. Moderate alcohol consumption
3. Regular exercise

What does the test content consist of?
The NAMS Certified Menopause Practitioner exam breaks down the test content as follows: 19% on physiology and pathophysiology of the menopause transition; 20% on symptoms and concerns; 21% on health disorders of midlife; 19% on preventive care and counseling; and 21% on treatment options for common menopausal symptoms. The index of specific topics, concerns and issues covered under these headings appears to be quite comprehensive, which provides the impression that no provider who is NAMS-certified should be minimizing women’s symptoms or writing them off as unrelated to perimenopause.

How much does the NAMS certification test cost?
For NAMS members, the test fee is $200, and for non-members, it’s $400.

Why are women’s experiences with NAMS-certified providers so mixed?
I visited two NAMS-certified OB/GYNs. One agreed I was likely perimenopausal, but prescribed birth control pills, which are not recommended first-line treatment for perimenopause or the specific symptoms I was enduring. The other was skeptical that I was in perimenopause, told me I was “too young” and wanted to prescribe an SSRI antidepressant. From what I’ve seen online, mainly in virtual communities, women have very mixed experiences with NAMS providers. Some had very positive encounters and were treated seriously and given effective options, and many have had poor reports of not being taken seriously, being told perimenopause was an impossibility, being told to do more yoga and take deep breaths, and other unbelievable, incredulous things.

I believe there should be some reporting system in place, one wherein women could share with NAMS their experiences with such providers, both good and bad. Without this mechanism in place, and with such discrepancies in reported experiences with NAMS providers, the organization is risking its reputation by extension. There needs to be more quality assurance in place to ensure greater consistency and continuity among providers who hold the NAMS badge.