Objective: Elicit preferences for treatment of vasomotor symptoms (VMS) associated with menopause. Design: Discrete choice experiment. Setting: Australia, Canada, Denmark, France, Germany, Spain, Sweden, United Kingdom. Population: Women aged 40–65 years, postmenopausal, self-reporting ≥14 moderate-to-severe VMS episodes/week. Methods: Targeted review of published literature, steering committee feedback, iterative qualitative interviews and available clinical data identified potentially relevant attributes of VMS treatments. Main Outcome Measures: Women made a series of choices between two hypothetical treatments and an opt out differing in moderate-to-severe VMS frequency, other menopause symptom improvement, time to symptom improvement, 5-year risks of breast cancer, blood clots and osteoporosis. Data analysed using a mixed-methods approach. Relative attribute importance (RAI) captured the maximum contribution of each attribute to treatment choice depending on expected duration of hormone therapy (HT). Results: The most influential attribute was 5-year blood clot risk (RAI 26.4–28.4%). Improving other menopause symptoms had a 1.4 times greater effect on preferences than reducing VMS frequency. Based on 5–9 years’ HT use (RR 1.97), breast cancer risk was the fourth most important attribute. Improvements in other menopause symptoms, VMS frequency reduction, onset time and of osteoporosis risk reduction were 1.0–1.4 times more important than remaining attributes. Women were willing to accept an extra 0.5% blood clot risk of or an extra 0.25% breast cancer risk for every 10% reduction in VMS frequency. Conclusions: Women valued safe efficacious VMS treatment, with high importance on avoiding long-term risks. Reducing VMS frequency mattered over and above wider menopause symptoms.