Huang et al analyzed self-reported data from 3167 older postmenopausal women to gain insight into why hot flushes persist for some women but not others. In this cohort of women who were predominantly 5 or more years postmenopausal, 12% reported hot flushes that were bothersome or interfered with their lives. Women were more likely to report hot flushes if they had fewer years of education, were more recently menopausal, had previously used estrogen, had previously undergone hysterectomy, or had other symptoms of menopause. Hot flushes were also associated with higher body mass index, higher follicle-stimulating hormone levels, and lower high-density lipoprotein cholesterol levels but not estradiol levels. Nearly half of women with bothersome hot flushes at baseline continued to have symptoms 3 years later, suggesting that for a substantial minority of women, hot flushes are a persistent source of discomfort well into the late postmenopausal years.