ObjectiveTo find predictors of hot flashes at natural menopause.MethodsA cross-sectional sample of 334 black and white, naturally menopausal women was selected from a control group in a population-based study of reproductive cancers in central North Carolina. Women reported whether they had experienced hot flashes at the time of menopause. Life-style factors and reproductive histories of those with and without hot flashes were compared.ResultsCompared to women who were older at menopause, those reporting natural menopause before age 52 years had a significantly increased probability of having hot flashes (prevalence ratio 1.5,P= .04). Less than a high school education was significantly related to an increased probability of hot flashes (prevalence ratio 1.4,P= .02). There was significant interaction between cigarette smoking and body mass index (BMI), so that thin women who smoked in the premenopausal period were most likely to experience hot flashes (prevalence ratio 1.9,P= .03). Among non-smokers, BMI appeared to have no effect on the probability of hot flashes. Alcohol use, although not statistically significant, suggested a positive relation with hot flashes over and above that incurred from smoking. In addition, menarche before the age of 12 (prevalence ratio 0.6,P= .08) and a history of irregular menstrual cycles (prevalence ratio 0.6,P= .08) were marginally related to a decreased prevalence of hot flashes. Race, parity, and age at first and last pregnancy had no relation to hot flashes.ConclusionSocioeconomic factors and those related to the decline of estrogen production are related to the occurrence of hot flashes at the time of menopause.