Vasomotor symptoms (VMS) – hot flashes and night sweats – are one of the most frequent symptoms of the menopause transition. While moderate to severe VMS have been associated with an increased risk for cardiovascular disease, the mechanisms underlying this relationship are not fully understood. One possibility may involve VMS’ link with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, the body’s primary stress system, which releases the stress hormone cortisol. VMS have been related to an altered cortisol profile, including decreased morning cortisol, though the direction of the VMS-cortisol relationship is unknown. The current study aimed to determine the direction of this relationship. Of 82 healthy women ages 45-55 from the community, 13 women who were quite a bit or extremely bothered by VMS were included in the analysis, in the menopause transition. Once a week for 12 weeks, participants completed questionnaires on their hot flashes, mood, and sleep and provided two saliva samples for the measurement of cortisol: one immediately after waking up and one 30 minutes after waking up. A linear mixed model (PROC MIXED in SAS 4.3) indicated that although past-week CAR change was predictive of the number of severe VMS, past-week VMS change was a better predictive of the CAR. Past-week severe VMS change, total VMS change, and VMS score change was a statistically significant predictor of weekly morning cortisol. The current study indicates that treating the VMS directly rather than HPA axis dysregulation would better reduce the severity of the symptoms and reduce the HPA axis dysregulation.