Menopause is associated with declining levels of estrogens. Menopause transition, a time four to six years prior to the Final Menstrual period has fluctuating hormonal levels. Vasomotor symptoms (VMSs) occur more so in late transition and early post menopause. Woman has feeling of warmth, hot flushes, may be chills, anxiety, and night sweats. It affects 40–70% women across the globe with Asian women having a lower incidence. Estrogen withdrawal is associated with over stimulation of neurons of hypothalamic thermoregulatory neutral zone and leads to dysregulation of body temperature. VMS are associated with smoking, obesity, hypertension, and higher cardiovascular disease risks. Frequency and severity of the VMS may be graded. A detailed history and examination is needed to rule out other diseases like hypertension, cardiovascular disease, carcinoid syndrome, etc. These may have a similar presentation. Life style management with cooling environment, less spicy food, cotton clothes may be tried. Cognitive behavioral therapy is helpful. For moderate-to-severe VMS Menopausal hormone therapy is indicated if woman is within 10 years postmenopause or less than 60 years of age. Tibolone is also helpful. Nonhormonal therapy with Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) is also effective. Neurokinin B antagonists Fezolinetant has been found to be effective. Gabapentin a drug used for neuropathic disorders is also useful. Vasomotor symptoms may be used as one of the risk factors predicting CVD in future for the women.