Abstract Disclosure: E. Armeni: None. A. Augoulea: None. I. Karagkouni: None. I. Avgousti: None. M. Charamanta: None. S. Stergiotis: None. I. Lambrinoudaki: None. Introduction: Reproductive aging and ovarian senescence are associated with accelerated accumulation of cardiometabolic risk factors, but also progressively increasing risk for cardiovascular disease (CVD). Metabolic-dysfunction-associated steatotic liver disease (MASLD) is linked with a higher risk for CVD. The prevalence of MASLD with regards to reproductive aging, and the possible link with vasomotor symptoms has not been evaluated yet Methods: For the purpose of this cross-sectional study, we evaluated 106 peri- and postmenopausal women, retrieved from the outpatient Menopause clinic of the Second Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece. The extent of steatotic liver disease (SLD) was estimated as values of the fatty liver index; using the known cut-off ≥ 60 for higher risk for SLD. MASLD was defined as the presence of ≥1 of the following risk factors in a woman with hepatic steatosis: 1) body mass index (BMI) ≥25 kg/m2 or waist circumference ≥85 cm; 2) fasting glucose ≥100 mg/dL or type 2 diabetes or hypoglycemic treatment; 3) blood pressure ≥130/85 mmHg or antihypertensive treatment; 4) triglycerides ≥150 mg/ dL or related treatment; and 5) high-density lipoprotein cholesterol ≤40 mg/dL or lipid-lowering treatment. The severity of vasomotor symptoms (VMS) was assessed using the Greene Climacteric Scale. Results: Moderate-to-severe VMS were evident in 42 women of our sample while 64 women had no-to-mild severity of VMS. Logistic regression analysis showed that moderate-to-severe VSM, as opposed to no-to-mild symptoms, were associated with MASLD (MASLD rates, moderate-to-severe VSM vs no-to-mild: 26.2% vs 12.5%, p-value=0.072; OR = 3.022, p-value =.041). This association became even stronger when we restricted the sample to early postmenopausal women (up to 5 years after the final menstrual period, N=57, VMS no-to-mild vs moderate-to-severe, 3.6% vs 24.1%, p-value = 0.025; OR=9.333, p-value=0.045). The models were adjusted for age, physical exercise, alcohol intake, current smoking, history of menstrual irregularity, and HRT use. Conclusion: The results of this study indicate that the severity of vasomotor symptoms is associated with the diagnosis of MASLD in midlife women, irrespective of the use of HRT. These observations underscore the importance of cardiovascular risk assessment in women with bothersome vasomotor symptoms. Presentation: 6/3/2024