Vasomotor syndrome is the most commonly complained syndrome in menopause women. The main mechanism is the decrease in estrogen which causes increasing of body's core temperature and overactivity of the parasympathetic nervous system. Estradiol is the most abdudant and most potent estrogen derivate that works in major receptors throughout the body. This study aimed to determine difference of estradiol serum levels between women with and without vasomotor syndromes and among the symptoms severity. This study was conducted in 50 menopausal women in the Department of Obstetrics and Gynecology H. Adam Malik Hospital, Medan, Indonesia. Vasomotor symptoms was assessed by interview using three options of answers. Estradiol serum was analyezed using chemiluminescent principle in Prodia Laboratory. Data were tabulated and analyzed by SPSS. This study showed significant difference of mean estradiol serum levels between women with and without vasomotor syndromes (17.5 and 47.5 pg/ml, respectively; p=0.0001). Women with mild vasomotor syndromes had higher estradiol serum levels (23.9-29 pg/ml) than those with moderate (12-19.7 pg/ml) and severe (11.8 pg/ml) degree of syndromes. By using estradiol level as a marker, the presence vasomotor symptoms even its severeity should have been predicted earlier. Therefore, women can prepare to overcome those debilitating symptoms. Further and larger reseach is needed to make this study applicable in all clinical settings.