**Question:** Basanti Devi, a 45-year-old woman, presents with hot flushes after stopping her menstruation. 'Hot Flush' can be relieved by administering the following agents:

A. Estrogen
B. Progesterone
C. Gonadotropin-releasing hormone (GnRH) agonists
D. Selective serotonin reuptake inhibitors (SSRIs)

**Correct Answer:** **D. Selective serotonin reuptake inhibitors (SSRIs)**

**Core Concept:** Hot flushes are common symptoms experienced by postmenopausal women, occurring due to the decline in oestrogen levels. Hot flushes are characterized by sudden episodes of sweating, increased heart rate, and facial flushing. In postmenopausal women, the reduction in oestrogen levels leads to increased sensitivity of thermoreceptors in the skin, causing vasodilation and blood rush to the surface, leading to flushing and sweating.

**Why the Correct Answer is Right:** In postmenopausal women, hot flushes are primarily due to the decline in oestrogen levels, which results in reduced vaginal mucosa thickness, vasomotor instability, and increased sensitivity of thermoreceptors in the skin. Oestrogen is a crucial hormone for maintaining skin and mucous membrane integrity. SSRIs are a type of antidepressant that work by inhibiting the reuptake of serotonin, leading to increased serotonin levels in the synaptic cleft. This increased serotonin helps in reducing the vasomotor symptoms of hot flushes by modulating the hypothalamic-pituitary-ovarian axis and promoting the synthesis of oestrogen.

**Why Each Wrong Option is Incorrect:**

A. Estrogen: While estrogen is essential for postmenopausal women, it is not the primary treatment for hot flushes due to its role in hormone replacement therapy (HRT). HRT is contraindicated in women with a history of venous thromboembolism, breast cancer, or stroke.

B. Progesterone: Progesterone is a hormone produced by the corpus luteum during pregnancy and in the ovaries during the luteal phase of the menstrual cycle. Progesterone is not primarily involved in the pathophysiology of hot flushes.

C. Gonadotropin-releasing hormone (GnRH) agonists: GnRH agonists are used to suppress gonadotropin secretion in menopausal women with severe vasomotor symptoms and bone loss. They are not the primary therapy for treating vasomotor symptoms like hot flushes.

D. Selective serotonin reuptake inhibitors (SSRIs): As mentioned above, SSRIs are used to increase serotonin levels in the synaptic cleft, which helps in reducing the vasomotor symptoms of hot flushes. SSRIs are a safer and more targeted treatment option compared to hormone replacement therapy (HRT).

**Clinical Pearls:**

1. Hot flushes in postmenopausal women are often seen during the transition