Hot flushes and night sweats are the predominant symptoms of menopause and usually, they are referred to as vasomotor symptoms. The mechanisms of increases in skin blood flow during hot flushes may include the withdrawal of sympathetic vasoconstrictor activity, increases in sympathetic cholinergic vasodilator activity, or a combination of both neural mechanisms and nonneural factors, with increased white matter hyperintensities suggesting that the relationship between hot flushes and cardiovascular risk observed in the periphery may extend to the brain. The impact of vasomotor symptoms on mood and quality of life may be considerable and is often underestimated. Vasomotor symptoms were associated with decreased health-related quality of life, and baseline depression and obesity amplified this negative association. Hormonal therapy reduces the frequency and severity of hot flushes, with health benefits when started near menopause, particularly for women with early menopause. Several nonhormonal therapies including antidepressant drugs were also found effective for vasomotor symptoms over placebo. New nonhormonal neurokinin 3 receptor antagonist and dual neurokinin 1,3 receptor antagonists therapies open up a new avenue for the treatment of vasomotor symptoms with targeted therapies that do not require estrogen replacement.