Hot flushes are among the most common concerns of women during menopause and persist for 5 or more years past menopause in as many as one-third of women.1 These common symptoms can negatively affect women’s quality of life by disrupting sleep, interfering with work and leisure activities, and exacerbating anxiety and depression.2 The pathophysiology of hot flushes is poorly understood, although alterations in hypothalamic thermoregulation3 or endothelial function4 are hypothesized to play a role. With recent randomized trials documenting the adverse effects of long-term postmenopausal hormone therapy,5,6 there has been growing interest in identifying alternate strategies to alleviate these symptoms. In multiple observational studies,7–9 women with a higher body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) have reported more frequent or severe hot flushes compared with women with a lower BMI. It is currently unclear whether the observed relationship between a higher BMI and flushing is owing to greater insulation from peripheral fat, metabolic factors associated with visceral fat, or other clinical or lifestyle factors that exert independent effects on flushing. In addition, evidence of a beneficial effect of weight loss on hot flushes in women who were overweight is lacking, and some studies10–12 have raised concerns that women who increase their physical activity in an effort to lose weight may experience worse flushing symptoms. We conducted an ancillary study to the Program to Reduce Incontinence by Diet and Exercise (PRIDE) study, a randomized controlled trial of an intensive behavioral weight loss intervention vs a structured education program to promote weight loss in women who were overweight or obese and had urinary incontinence.13 Our goal was to assess whether the intensive weight loss intervention was associated with significant improvement in bothersome hot flushes compared with the control program. We also examined whether changes in weight, BMI, abdominal circumference, physical activity, calorie intake, blood pressure, and overall physical or mental functioning were associated with improvement in bothersome hot flushes in this population.