Vasomotor disturbances are the most characteristic symptoms experienced during the climacteric. Not all perimenopausal women, however, experience hot flushes or sweating. The prevalence of these symptoms is subject to wide cultural differences, being appreciably higher in Western women than in women from developing countries, where the menopause generally seems to be associated with fewer complaints.8,9 In Europe and North American over 80% of women experience flushing at some time during the perimenopause (A Oldenhave, sixth international congress on the menopause, Bangkok, 1990), and many seek treatment for this.