OBJECTIVE:To review evidence of cultural differences in both biologic and nonbiologic factors as possible explanations for variation across cultures in self-reported vasomotor symptoms from surveys. DESIGN:Literature review and cross-sectional and longitudinal comparisons of ethnic groups with respect to patterns of symptom reporting from the Study of Women's Health Across the Nation (SWAN). RESULTS:The evidence to date indicates that cultural differences in vasomotor symptom reporting on surveys reflect both differences in the underlying biology, which ar likely to influence vasomotor symptom occurrence, and differences in nonbiologic sociocultural factors such as attitudes toward menopause, which are likely to be related to vasomotor symptom perception and reporting, CONCLUSIONS:It is important to consider interactions of culture and biology in studies of vasomotor symptoms. Recommendations for future studies include using both open- and closed-ended questions, including measurements of objective indicators such as reproductive hormone concentrations, measuring both culturally related biologic and nonbiologic factors related to vasomotor symptom occurrence or reporting, and using the same general study protocol for multiple cultural groups being compared.