Hot flashes are the most common specific symptom of perimenopausal women, which seriously endangers their physical and mental health and quality of life. Because the pathogenesis of hot flashes is not yet clear, and existing estrogen replacement therapy has many limitations and contraindications, it is particularly urgent and important to explore the pathogenesis of hot flashes and find new therapeutic targets. Recent studies suggest that abnormalities of KNDy neurons in the arcuate nucleus of hypothalamus when estrogen decreases during perimenopause are the key factors that trigger hot flashes. Some scholars believe that KNDy neurons in the arcuate nucleus are involved in the occurrence of hot flashes by regulating the pulse release of gonadotropin-releasing hormone and its downstream luteinizing hormone, while some other scholars believe that KNDy neurons in the arcuate nucleus play a key role in the process of hot flashes by regulating the median preoptic nucleus of the hypothalamic preoptic are    a. Therefore, this review intends to summarize the above two types of current relationship between the KNDy neurons in the arcuate nucleus and the occurrence of hot flashes and the possible mechanisms by which KNDy neurons participate in hot flashes, and lay a theoretical foundation for the exploring of new targets and method  for the treatment of perimenopausal hot flashes.