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This paper is the review of modern literature, which reflects data on novel views on the regulatory mechanisms of the hypothalamic-pituitary-ovarian axis and data on the genesis of hot flushes, including on the central mechanism with the participation of vasomotor triggers and on the effector mechanism with the involvement of vascular factors, as well as on new possibilities of pathogenetic therapy for hot flushes, which can become an alternative to menopausal hormone therapy. The probable associations of hot flushes with the genetic polymorphism of estrogen metabolizing enzymes, as well as with diseases, the onset and development of which are observed during the menopausal transition and postmenopause, are described. Hot flushes can have unified pathogenetic components and be related to various somatic diseases and adverse events in postmenopause. Therefore, a search for the methods of their control and therapy is important and investigations of this matter are promising. With this in mind, it is necessary to continue investigations of the pathogenetic mechanisms of menopausal vasomotor symptoms.

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