Objectives Perception of physical symptoms is an important factor in medical help‐seeking. We aimed to examine both physiological and subjective measures of a commonly reported physical symptom—vasomotor symptoms (hot flushes and night sweats; HF/NS), and to investigate factors that might influence symptom perception, that is, concordance, over‐reporting, and under‐reporting of symptoms in healthy menopausal women. Methods One hundred and forty women completed questionnaires assessing depressed mood, anxiety, stress, somatic symptoms, beliefs about HF/NS, and somatic amplification. Subjective and objective (24‐h sternal skin conductance) measurements of HF/NS were obtained to assess concordance. Results Thirty‐seven percent of HF/NS were concordant while 47 and 16 % were under‐reported and over‐reported, respectively. Depressed mood, anxiety, somatic symptoms, and negative beliefs about HF/NS were associated with (higher) concordance, (less) under‐, or (more) over‐reporting. Negative beliefs about night sweats and sleep were the strongest predictors of concordance, whereas additional somatic symptoms and smoking predicted over‐reporting. Conclusions Just over one third of physiologically recorded HF/NS were perceived as hot flushes; under‐reporting of symptoms was more common than over‐reporting. Interestingly, women who were more accurate in detecting physiological HF/NS tended to report more psychological and somatic symptoms and negative beliefs about HF/NS. Both measures should be included as outcomes of clinical trials. Am. J. Hum. Biol. 26:389–394, 2014. © 2014 Wiley Periodicals, Inc.