For a woman in her mid-40s to mid-50s, it arrives without warning. She wakes up, overheated, wondering why it’s so hot in the house—until she sees the thermostat is set for 70 degrees, same as always. Or, she’s midway through a work presentation when heat rises from her chest to her face, and she wonders if the flush on her cheeks is visible to everyone in the room.
It’s a hot flash—a rite of passage for the majority of women in either perimenopause, the years leading up to menopause, or the years beyond it. Menopause itself is diagnosed after 12 consecutive months without a period, but the hot flashes don’t always get the memo.
Here’s everything doctors currently know about hot flashes.
What is a hot flash, and who gets them?
Hot flashes are a sudden heat flare up often paired with flushed skin and sweating. They don’t usually last long, between a minute and five minutes in duration.
Most women experience a hot flash about four and a half to five years after their last period, Dr. Monica Christmas, an OB/GYN at University of Chicago Medicine and director of its menopause program tells Popular Science. She also is the associate medical director of the nonprofit Menopause Society, which provides healthcare professionals with tools and resources to support women through the transition.
Women have grappled with hot flashes—whether simply annoying or genuinely debilitating—for centuries. In 1582, Dr. Jean Liebault of France was among the first to document the phenomenon. But while we know much more about hot flashes and night sweats than Liebault ever did, one question still stumps experts.
“What we can’t answer is why doesn’t everybody get them,” Christmas says. “Because everybody doesn’t get them. I have patients that will say, ‘I don’t know,’ if I say, ‘Are you having any hot flashes or night sweats?’ And as soon as they say that, I’m like, ‘You’re not having them.’”
What’s actually happening inside women’s bodies during a hot flash?
During a hot flash, a woman might feel like she’s spiking a high fever, but physiologically, that’s not what is happening. As women approach menopause and the ovaries begin to make less estrogen, the brain’s internal thermostat—the hypothalamus—becomes hypersensitive to even small shifts in temperature, Christmas says.
The body “thinks” it’s overheating, even when the actual temperature hasn’t changed much. In response, our bodies try to cool us down. Blood vessels dilate, which is supposed to help dissipate some of that heat, but then that triggers a sweating reflex.
“Many people will say, ‘I feel this out of nowhere, this surge of warmth that typically is from the nipple line up,’” she says. “And then as soon as the heat came on, and I felt like I was internally heated up or on fire, I start to sweat.”
Exactly how an individual woman experiences hot flashes varies wildly. Some describe very mild symptoms. Others grapple with profuse sweating. Some experience only hot flashes during the day, while some have regular night sweats. About four in five women experience them at some point during the menopause transition, according to the American College of Obstetricians & Gynecologists.
“There’s a lot of variability,” Christmas says. Common triggers include alcohol, caffeine, high-sugar and highly processed foods, along with stress.
Black women also are more likely to experience more severe and longer-lasting symptoms, sometimes up to 11 years, she says. And research also shows that women with more severe, longer-lasting hot flashes and night sweats appear to be at higher risk of cardiovascular disease.
That doesn’t mean treating hot flashes automatically lowers heart risk, Christmas says. But it does reinforce that these women deserve particularly careful attention to blood pressure, cholesterol, and lifestyle. “I want to make sure I’m doing everything possible to minimize that risk,” she says when she treats her patients.
There’s more to hot flashes than hormonal changes
For decades, the entire process was blamed purely on estrogen loss, Christmas says. But that explanation left some unanswered questions.
“That doesn’t explain why every menopausal woman doesn’t have night sweats,” she says. “And it also doesn’t quite explain why we can sometimes start to experience them during the perimenopause transition because during perimenopause, people still have some estrogen.”
Newer research now is telling a more complex story. When the brain recognizes that a woman’s estrogen levels are low, nerve cells in the hypothalamus called KNDy neurons (pronounced “candy”) become overactive, releasing neurotransmitters, which are chemical signals the brain uses to send messages throughout the body. These neurotransmitters include kisspeptin, dynorphin, and neurokinin B.
“It’s actually those neurotransmitters that seem to have more of an impact on our ability to regulate our internal temperature,” Christmas says. “They’re not hormones.”
What to do if you get a hot flash
For women in the middle of their hot flash years—along with the 10 percent of menopausal women who continue to experience them—there are treatments.
Estrogen-based hormone therapy can help, but not every woman, including those with a history of blood clots or breast cancer, can take hormone therapy.
Hormone therapy can help alleviate hot flashes. Video: Hormone therapy – Four things a Mayo Clinic women’s health specialist wants you to know., Mayo Clinic
Fortunately, researchers’ new understanding about the role of KNDy neurons has allowed for new treatments that block the brain signals that trigger hot flashes in the first place. The FDA approved a new drug called Veozah (it’s chemical name is fezolinetant) in 2023. It targets the neurokinin 3 receptor, which plays a key role in regulating body temperature.
Lynkuet, another drug (with the chemical name elinzanetant), came along in 2025. It blocks both the neurokinin 1 and neurokinin 3 receptors, interrupting the process that triggers hot flashes at two points instead of one.
Other medications can also provide relief, though weren’t originally developed for hot flashes, Christmas says. Some SSRIs and SNRIs; gabapentin, a neurologic medication; and oxybutynin, used for overactive bladder, are all used off-label for hot flashes and night sweats.
Cognitive behavioral therapy and hypnosis also have been shown to reduce hot flashes. “I’m menopausal, too, so I know if I’m under a lot of stress or in a stressful situation, I’m going to probably have more hot flashes than not,” Christmas says.
“So there’s certainly something about being able to calm our central nervous system down that seems to have an impact, too.”
If you’re struggling with hot flashes, Christmas recommends seeing your healthcare provider for help. Treatments are available. What’s more, in some cases, hot flashes or night sweats could signal other issues, including thyroid disorders, cancer, and infections, among others.
But bottom line, when it comes to hot flashes, you don’t have to sweat them out.
In Ask Us Anything, Popular Science answers your most outlandish, mind-burning questions, from the everyday things you’ve always wondered to the bizarre things you never thought to ask. Have something you’ve always wanted to know? Ask us.
In a family of killer diseases, pancreatic cancer has long been one of the scariest. It could grow undetected for years, and by the time most people knew something was wrong, their prognosis was grim. The vast majority of patients, nearly 90 percent, would die within the first five years of their diagnosis. Even as other cancers saw their mortality rates drop in recent years, pancreatic cancer’s death rate actually increased slightly from 1999 to 2020.
And despite their best efforts, scientists felt stuck. In the 1980s, they identified a gene, KRAS, that seemed to be pivotal to the uncontrolled cell growth that drove the disease’s development. But over and over again, most treatments in clinical trials failed. Dr. Anirban Maitra, director of NYU Langone’s Laura and Isaac Perlmutter Cancer Center and a longtime pancreatic cancer researcher, told me that pharmaceutical companies came to regard pancreatic cancer as a “graveyard” for future drug development. Experts feared the gene was, in effect, “undruggable,” Maitra said.
But recent breakthroughs have brought what once seemed impossible within reach. A group of researchers is preparing to publish results from their clinical trial, already reported in the New York Times, that found a KRAS-targeting pill called daraxonrasib roughly doubled survival, from seven months to 13 on average, among a group of patients who had metastatic pancreatic cancer and had already tried chemotherapy.
“For the first time, there is some optimism in this disease,” Maitra told me. “Oncologists who have been treating this cancer for decades have always been so pessimistic about the fact that so many trials have failed. These patients, unfortunately, live for a few months and die. But now we finally have the foundation on which to build.”
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Effectively treating pancreatic cancer — or even possibly, some day, curing it — will ultimately demand more than one successful clinical trial. It’ll require improving the full spectrum of care, which means identifying who is at risk, detecting the disease early, and producing even more effective treatments that can offer patients hope of many more years to live, not just more months.
We are getting closer to being able to diagnose and treat pancreatic cancer with remarkable precision. Here’s what it will take to get all the way there — and what everyone should know.
Doctors are getting better at figuring out who’s at risk
One major problem with pancreatic cancer is that your pancreas is buried deep in your abdomen. You could have cancer growing there for years with no symptoms. Improving the outlook starts with detecting it early — and that work begins with figuring out who is most at risk.
Many people, and even doctors, may not be aware of what to look out for, Maitra told me. There have been some high-profile deaths that temporarily put the disease in the public eye — actor Patrick Swayze, tech titan Steve Jobs — but it hasn’t been the focus of major awareness campaigns like breast or even more recently colon cancer. Pancreatic cancer accounts for about 3 percent of all cancer cases — but more than 8 percent of cancer deaths, about 39,000 every year.
Smoking, age, and obesity are all considered to be risk factors — but that is something pancreatic cancer shares with many other types of cancer. One unique risk factor is the sudden onset of adult diabetes, especially when accompanied by weight loss, Maitra said.
“If you’re like a 65-year-old and you’re presenting with new-onset diabetes and you just lost 10 pounds, I would be very worried about that person. I’d make sure I get some tests done on that person,” Maitra said. “Awareness is so important.” He clarified that most new-onset diabetes in an adult is just that, and isn’t a reason to panic. Still, he said, the connection is something more people and health care providers should be aware of.
New artificial intelligence programs could also help doctors identify who is most at risk. Hospitals are starting to experiment with scanning electronic health records or genetic samples, Maitra said, and singling out patients who may be at higher risk based on their medical history or the presence of certain genes that are associated with a greater chance of developing pancreatic cancer (including the breast cancer-causing gene BRCA2).
Clinicians have better tools for detecting pancreatic cancer early
Once doctors identify people who are at risk, they can deploy a host of new surveillance tools to look for pancreatic cancer’s development.
Blood tests, commonly referred to as liquid biopsies, have received a lot of investment, as well as mediaattention. Some companies aspire to create a test that could search for multiple cancers from one sample, but in the meantime, single-disease versions have shown promising if not quite ironclad results — including for pancreatic cancer. One blood test developed by Oregon Health & Science University had an 85 percent accuracy rate in diagnosing early-stage pancreatic cancer when it was used in tandem with an existing antigen test.
Once again, AI programs could help doctors get ahead of the disease. A recent study found that an AI program developed by Mayo Clinic researchers and used to examine routine abdominal CT imaging scans could spot pancreatic cancer at nearly double the detection rate of two human radiologists, finding the disease up to three years before a normal clinical diagnosis would occur.
“This is where AI can really help because they can pick out subtle patterns that the human eye can miss,” Maitra said.
Scientists are developing better pancreatic cancer treatments
Once doctors find the pancreatic cancer, they can treat it — and their options are getting better there too.
Maitra said the best treatment remains surgical removal plus therapy — and the smaller the tumor, the better, which is why early detection is so essential. It also prevents the cancer from having more time to metastasize and spread.
Even after surgery, the cancer can come back. But new vaccines are showing promise in preventing that kind of recurrence; small preliminary studies have identified multiple vaccine candidates that allowed patients to live longer without a relapse and survive overall longer than the historical norms for pancreatic cancer patients.
And for the people facing the most dire scenario, when their cancer cannot be removed by surgery, that’s where the new treatments targeting KRAS — the gene that drives pancreatic cancer’s growth — could be a game-changer.
To dramatically simplify the scientific breakthrough here, KRAS has been described by researchers as a “greasy ball” that for a long time no drug molecules were able to attach themselves to. As the Times reported, Kevan Shokat, a scientist at the University of California San Francisco, figured out how to make a molecule attach to KRAS in 2013; around the same time, Greg Verdine at Harvard University was working on a molecular “glue” that could disable KRAS. The new drugs build on this research to deliver a compound to the gene that can slow the out-of-control cell growth that causes pancreatic cancer.
But we should think of daraxonrasib, which seems likely to receive FDA approval, as the “ground floor” for this class of drugs, Maitra told me. Many people still do not respond to the treatment or experience severe side effects. The drug also stops working after a period of time, as people’s bodies develop a resistance to it. But other drugs that combine different molecules in an attempt to extend the treatment’s effectiveness are already in the pipeline.
In the future, pancreatic cancer treatment could end up becoming a combination of all of the above: early detection, surgical removal to get the bulk of a tumor out, with vaccines and/or KRAS-based treatments used to prevent the cancer from coming back. And people who can’t undergo surgery for some reason might try a combination of vaccines and KRAS-targeting drugs.
The work is far from finished. But for the first time, after decades of disappointments, there is real reason for hope.
A generation or two ago, when Americans had an important but nonemergency medical need, many of them would have called on their family doctor, somebody who had treated them for years. It was a little like going to a family restaurant: The purveyors knew you, knew your tastes and personal quirks, and they were part of the fabric of your community.
These days, patients aren’t visiting the family doctor nearly as frequently. They’re instead heading to what you might think of as drive-thru clinics — some physical, some entirely online — where they order off a menu, undergo a cursory and formulaic interaction with a healthcare provider they’ll never see again, and head off with the product they came to get. It’s like ordering a Big Mac at McDonald’s: When you pull up, you already know exactly what you want.
In some cases, this drive-thru healthcare approach is filling genuine holes in healthcare access for Americans who are in need, such as people in the United States who live in the states with restricted access to reproductive and abortion services, and who have had no choice but to seek help online from other providers out of state. Beyond that, we’re dealing with a doctor shortage. Wait times to see a physician for all types of care are getting longer and longer — and these new practices promise to put you in touch with one with a simple click of a button. They can also offer competitive prices compared to conventional medicine, even without taking insurance, because they have maximized their efficiency. They’ve eliminated a lot of overhead in terms of physical space or administrative workload. One provider can screen an enormous number of patients and rake in a lot of revenue, which allows the company to reduce their prices.
“The word of the day in health policy is affordability,” said Dr. Ateev Mehrotra, who chairs the Department of Health Services, Policy, and Practice at the Brown University School of Public Health and has studied these practices. “You can see how these can create a more affordable and accessible way” to get healthcare.
But replacing the traditional doctor-patient relationship with something brief and transactional presents real risks to patients and their long-term well-being. Some of the most common reasons for seeking these services — erectile dysfunction medications or hair loss treatments — could be signs of an underlying health condition that would benefit from a more serious conversation with a personal physician.
The trick is in knowing the difference — and that isn’t always easy to do. The US healthcare system in its current incarnation places an enormous burden on individuals to figure out the best way to get the care they need.
“A lot of quote-unquote empowered consumers are engaging in a lot of do-it-yourself medicine without necessarily understanding the limits of it,” Dr. Sachin Jain, who held several leadership roles in the Department of Health and Human Services during the Obama administration and is currently the CEO of the nonprofit Medicare Advantage insurance carrier SCAN Health Plan, told Vox. “I think even though there are more options for patients today than there were 30 years ago, the degree of fragmentation, in my view, is decreasing quality and truly eroding the patient experience.”
Drive-thru clinics don’t appear to be going anywhere — and that’s exactly why consumers need to be smart about how they use them.
In hundreds of communities, a doctor shortage is already here. Most of rural America, 80 percent of it, is considered by the federal government to be medically underserved. About 20 percent of the US population lives in rural communities, but only 10 percent of doctors practice there.
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“This notion that there’s going to be this available person who’s covered through your insurance, like who schedules visits with you and really gets to know you and is able to provide you with a comprehensive assessment, is just unavailable to most people,” Jain said.
Faced with these barriers, Americans have gravitated toward the convenience offered by urgent care facilities and “minute clinics” in pharmacies or large retail stores. The number of urgent care visits among privately insured Americans doubled from 2008 to 2015. In 2024, more than 80 percent of Americans said they had visited an urgent care or other kind of walk-in clinic; about 7 percent said in 2022 that it was their regular source of care.
The success of those businesses revealed Americans were comfortable with one-time-only healthcare. The idea of visiting a provider for one specific purpose predetermined by the patient started to take hold. As medical marijuana proliferated in the 2000s and 2010s, clinics popped up that offered the kind of routinized service that is now commonplace: Simply answer a few questions, and you’ll get the prescription you desire.
Today, that kind of service is available for an array of medical products and services, including erectile dysfunction pills, testosterone, GLP-1s, birth control, performance anxiety drugs, and Botox. They are finding an audience as Americans desire agency over their own healthcare — driven by the lack of access to conventional healthcare, distrust in the medical establishment, and wellness trends that prioritize self-optimization.
According to one consumer survey, 80 percent of Americans said that they own at least one personal medical device, which could include a blood pressure monitor or smartwatch. Nearly half prefer at-home or virtual care to visiting a doctor’s office. They increasingly consult Google or ChatGPT to investigate their own health before seeing a provider.
“We glorified do-it-yourself medicine through the lens of this idea of consumerism,” Jain said. “What consumerism has really done is it’s created a high degree of fragmentation in a customer base, where they may not fully understand or know what they need.”
Amid those trends, the old-fashioned image of a family doctor you’d call for any range of medical needs looks increasingly out-of-date and out of reach.
“It’s turning medical care into a commodity,” said John McDonough, a public health professor at the Harvard T.H. Chan School of Public Health and author of the new bookAmerica’s Wrong Turn: US Health Care in the Neoliberal Era. “You can buy the package of services. You can buy the individual services, and you can go to the store and pull it off the shelf.”
Medical care looks more like Hims and Hers, perhaps the most high-profile examples of this kind of limited-category telehealth. Visit their websites and it looks a lot like ordering at a fast-casual chain restaurant: Have better sex, grow fuller hair, lose more weight, treat menopause, and would you like a side of testosterone with that? In 2025, the company generated $2.4 billion in revenue, an increase of 59 percent from 2024; it now claims more than 2.5 million subscribers.
Many consumers are getting the convenience they desire, but others may feel that the patient experience suffers. Patients on social media who’ve used Hims and Hers, for example, will sometimes complain about how impersonal the interactions feel or worry the service is increasing their dose too quickly.
In a statement to Vox, Dr. Pat Carroll, chief medical officer of Hims & Hers, said:
Millions of Americans face real barriers to healthcare: long wait times, stigma, cost, and provider shortages. Digital health can help close these gaps in care but only when done responsibly.
At Hims & Hers, every treatment decision is made by a licensed, independent provider who reviews a comprehensive medical intake to determine clinical eligibility before anything is prescribed. No shortcuts. As patient expectations rise, that standard should be non-negotiable across the industry.
Why you should be cautious about using drive-thru medical services
The premise of these services is that the patient knows what they want. But even a well-informed patient is not a physician — and, at the same time, these business models are based on doctors selling a specific product, not necessarily on whether they are providing the most clinically appropriate care during this one-time interaction.
“What happened is a number of entrepreneurs started picking off specific pain points, like things that are true pain points for patients, where there’s no clean place to go, and created access,” Jain said. For example, you may not be able to find a dermatologist covered by your insurance but visit a Hims and Hers-type service, and “there’s going to be someone there who’s willing to use their medical license to actually give you the thing you need.”
Patients should be cautious about using these “drive-thru” services, given those misaligned incentives, experts told me. Two of the most popular uses — for men who are seeking treatment for impotence or hair loss — are instructive.
On its face, erectile dysfunction checks all the boxes for this kind of service: It’s a narrow medical question and there is an obvious drug for physicians to prescribe. People who might be embarrassed to bring the problem up can get the treatment they want after answering a few questions from a provider that they will never have to see again, without anybody else needing to know.
“The business model is the provider has a drug they’re trying to sell.”
Vivian Ho, Rice University healthcare economist
But erectile dysfunction can be a more complex medical question than “can you get an erection when you want to have sex?” It absolutely could be something as innocuous as older age, and therefore an ED drug is the right treatment. But it could be a sign of serious underlying health problems such as hypertension, diabetes, depression and anxiety, sleep apnea, and more.
“Good clinical practice suggests that you have to rule out underlying causes while you’re simultaneously treating it,” Jain said. “I think that’s the kind of stuff that gets lost in clinically sloppy protocols. Oftentimes, these ‘lifestyle conditions’ are the window into broader systemic issues that go untreated or undertreated.”
Likewise, losing your hair can simply be a byproduct of aging and thus responsive to a hair-loss treatment. But it can be an outward symptom of a more serious issue like hypothyroidism or, again, stress and anxiety. Performance anxiety, which some of these services will prescribe a beta blocker for ahead of, say, a public speaking engagement, could be a signal you have deeper issues with anxiety or depression.
Or take GLP-1 drugs, which have become a popular offering for telehealth services. As Vox has reported, these powerful drugs can be effective in helping people lose weight — but they can also have serious side effects, including dramatic loss of muscle mass. They require careful management in terms of eating the right diet and getting on the right kind of exercise regimen. Developing a holistic weight-loss plan would be best done in ongoing consultation with a doctor who knows you and your medical history.
But this is where the economics of drive-thru healthcare fail patients. The doctors who practice in them don’t necessarily make money by offering you the best personalized advice or looking at your health from a whole-person perspective. They make money by prescribing you the medication you came to get; some of these services even ship the drug to you directly themselves.
“The business model is the provider has a drug they’re trying to sell,” Vivian Ho, a healthcare economist at Rice University, told me. Some pharmaceutical ads now even allow you to click through to connect with a provider who will prescribe you the advertised drug.
Secret-shopper research has revealed the limitations of these types of services. When Mehrotra’s team tried out contraception telehealth clinics using different patient profiles, they found these services were generally very good at screening for the specific product that they offer. But the companies did not take a broader look at the person’s sexual and reproductive health.
“They never address the fundamental questions. No one ever asked about STDs. No one ever asked, ‘Did you get your Pap smear?’” Mehrotra said. “There’s some holes here in this.”
Why you may sometimes need a drive-thru clinic anyway
Of course, it’s easy to say that everyone should seek out a primary care physician for some of these services — but, given the access issues faced by many people, it’s not that simple. For a person who needs birth control but can’t get an OB-GYN appointment (wait times were up 33 percent in 2025 compared to 2022), using that uncurious drive-thru clinic might be better than the alternative if the alternative is nothing.
“If a woman wants a freaking birth control, she should have every right to get birth control. … There’s all sorts of research out there about birth control deserts in the world,” Mehrotra said. “So if that’s what she wants, go for it. … You could see how the rationale for these in the context of birth control could be quite viable.”
Jain told me that, in his ideal world, insured patients would at least have a specific general practitioner who would hopefully become their first stop for some of these medical needs. The emergence of direct primary care — where patients pay a flat fee for on-demand access to the same doctor or a group of doctors — could also provide a counterweight to drive-thru clinics. The premise of these practices is that you pay for a subscription to have a doctor on call whenever you need them, and that doctor will already know you and your medical history. But those services tend to target people well-off enough to pay those fees on top of health insurance premiums (or who can afford to just pay for everything out of pocket).
And there may be times when a one-time-only provider is a good option. Going to urgent care or a minute clinic can be convenient for minor medical needs like a strep test or a flu shot. Prior case studies have found that these facilities tend to operate under rigorous clinical protocols that guide the care they offer to their patients. The value proposition is clear: It’s readily available, it’s clinically sound — and it’s cheaper than going to the emergency room.
“When there’s a degree of clinical discipline that is really rigorous and where there’s a high degree of protocolization that ensures people are getting really high-quality care, I have no problem with it,” Jain said. “But a lot of times the work is highly superficial.”
Then there is at least one truly special case, where drive-thru clinics are providing a service to patients when they have no other options available: mifepristone and other abortion drugs in a post-Dobbs America. Requests for telehealth abortion care have doubled since the decision, according to the Center for Reproductive Rights. They have offered a vital lifeline to patients with an urgent healthcare need when the alternative is having to travel out of state: A recent report from the Guttmacher Institute found that the number of American women who lived in a state with a total abortion ban and traveled out of state for an abortion dropped in 2025 while, at the same time, telehealth visits for women in those states were on the rise.
The Supreme Court is still weighing whether to permit doctors to continue virtually prescribing mifepristone. For this special type of drive-thru clinic, the stakes are high.
“Women in the United States already face real health consequences, including preventable deaths, due to abortion care being denied or delayed,” wrote two women’s rights advocate at Human Rights Watch in May. “Ending telehealth provision would greatly worsen this crisis, especially for women and girls with limited financial resources, or with disabilities, and those living in states with abortion bans or in rural areas.”
But those abortion providers are, in the broader context of DIY healthcare, an exception that proves the rule. Without those services, patients would lose access to lifesaving medical care.
For other healthcare needs, however, convenience does not always equal quality. Buyer — and patient — beware.
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