Menopausal hot flashes are a significant problem for women. Hot flashes can impact on daily functioning, particularly when they disrupt sleep, leading to fatigue and irritability during the day. However, our knowledge about this primary complaint of menopausal women is far from complete. It is known that a hot flash is associated with thermoregulatory, cardiovascular, and endocrine changes. However, much is unknown about the phenomenology of hot flashes, such as the range of variability in the pattern and longitudinal course of hot flashes. Although estrogen plays a role in the etiology of hot flashes, the mechanism by which its withdrawal precipitates hot flashes and its replacement relieves them is not understood. Nor do we know what it is that triggers individual hot flash episodes. We are beginning to learn about factors, such as ambient temperature, that modulate the frequency of severity of hot flashes. And very new data suggest that the ingestion of certain foods may influence hot flashes via estrogenic substances present in the food plants. Although there is much anecdotal information about herbs and other nonconventional remedies, little or no research had been done to assess the efficacy or safety of these methods for the treatment of hot flashes. An immediate focus on some of the most promising of these therapies could broaden the available treatment options and should provide new insights into the mechanism underlying hot flashes.