Finding Links Between Hot flASHes and CardioVascular Disease

Inclusion Criteria: * Age 40-65 years * Peri- and post-menopausal women (STRAW -1 to +1) * Moderate or high vasmotor symptom burden * Cardiometabolic disease (as evidenced by ≥ 2 of the following): * Obesity (body mass index ≥ 30 kg/m2) * Elevated waist circumference (≥ 88 cm) * Elevated triglycerides (≥ 150 mg/dL or drug treatment) * Reduced HDL-cholesterol (\<50 mg/dL or drug treatment) * Elevated blood pressure (≥ 130 mmHg systolic blood pressure or ≥ 85 mmHg diastolic blood pressure, or drug treatment) * Elevated fasting glucose (≥ 100 mg/dL or drug treatment) Exclusion Criteria: * Inability to provide informed consent or comply with study protocol * Major comorbidities: cancer, end-stage renal (eGFR \<45 mL/min/1.73 m2), liver or lung disease * Concomitant use of strong or moderate cytochrome P450 3A4 inhibitors * Elevated liver function tests (ALT, AST, and/or total bilirubin ≥2x ULN) * Undiagnosed uterine bleeding over past 6 months