Vasomotor symptoms are the most common medical complaint of perimenopausal and postmenopausal women. Frequent vasomotor symptoms can be disabling, affecting a woman's social life, psychological health, sense of well-being and ability to work. Women with hot flushes are more likely to experience disturbed sleep, depressive symptoms and significant reductions in quality of life as compared to asymptomatic women. Despite the prevalence and impact of these symptoms, the pathophysiology of hot flushes is unclear; however, estrogen withdrawal clearly plays an important role. It is postulated that declining estrogen concentrations may lead to changes in brain neurotransmitters and instability in the hypothalamic thermoregulatory center. The most effective therapy for relieving vasomotor symptoms and reducing their impact on quality of life is hormone therapy. Other options for women who decline hormone therapy include selective serotonin reuptake inhibitors and related agents. Most herbal therapies that have been evaluated in placebo-controlled trials have shown no clinically significant benefit.