Background: Microalbuminuria creatinine ratio, on the other hand, is a marker of kidney dysfunction and cardiovascular risk. It has been suggested that microalbuminuria may reflect endothelial dysfunction, which is characterized by impaired blood vessel function. Endothelial dysfunction has been implicated in the pathogenesis of Vasomotor symptoms (VMS). Aim: assessment of the Correlation between Microalbuminuria Creatinine Ratio with severity of Vasomotor symptoms in Postmenopausal Women. Methods: This Comparative cross-sectional study was conducted at the Endocrinology unit & clinic, Internal Medicine Department, Zagazig University Hospital, on 74 cases with Postmenopausal status Patients were divided into to 2 groups: Group I: Postmenopausal women without VMS, Group II: Postmenopausal women with VMS. The MVS survey was done to all cases, creatinine, albumin in urine, urinary albumin to creatinine ratio (UACR) Measurement were assessed. Results: there are statistical significant differences in studied groups regarding UACR , Mean± SD was (8.45 ± 5.29 vs 236.54 ± 406.55) in Group I and Group II respectively p-value <0.001, that were higher in Group II, vasomotor symptoms were present in (0% VS 100%, in Group I and Group II respectively p-value <0.001), 45% of the cases in Group II had UACR 7.35+0.39, 35% of the cases in Group II had UACR 3.24+0.33 and, 7% of the cases in Group II had UACR 17.52+0.55. There are positive Correlation between UACR, and VMS severity (P<0.05). This table shows that there were statistically significant positive correlations between HOMA-IR score and: body mass index, UACR, Fasting Insulin, HBA1C, FBS, PBS, HDL, TGs, cholesterol and e FGR to VMS (P<0.001) also statistically significant negative correlation between VMS and age. (P<0.05). Receiver operating characteristics (ROC) curve was used to Analysis of UACR as predictor test for the severity of VMS the best cut off value of UACR was ≥3.25, with sensitivity of 100%, specificity of 92% positive predictive value of 91.6%, negative predictive value of 90%. We concluded that UACR at cutoff value = 3.25 was a good predictor test for the severity of VMS in postmenopausal women.