The vagina is an internal organ with a complex ecosystem, influenced by circulating hormone levels which change during the menstrual cycle, pregnancy, breastfeeding and menopause.

Around and after menopause, there are normal changes in the growth and function of vaginal cells, as well as the vagina’s microbiome (groups of bacteria living in the vagina). Many women won’t notice these changes. They don’t usually cause symptoms or concern, but if they do, symptoms can usually be managed.

Here’s what happens to your vagina as you age, whether you notice or not.

Let’s clear up the terminology

We’re focusing on the vagina, the muscular tube that goes from the external genitalia (the vulva), past the cervix, to the womb (uterus). Sometimes the word “vagina” is used to include the external genitalia. However, these are different organs and play different roles in women’s health.

What happens to the vagina as you age?

Like many other organs in the body, the vagina is sensitive to female sex steroid hormones (hormones) that change around puberty, pregnancy and menopause.

Menopause is associated with a drop in circulating oestrogen concentrations and the hormone progesterone is no longer produced. The changes in hormones affect the vagina and its ecosystem. Effects may include:

• less vaginal secretions, potentially leading to dryness
• less growth of vagina surface cells resulting in a thinned lining
• alteration to the support structure (connective tissue) around the vagina leading to less elasticity and more narrowing
• fewer blood vessels around the vagina, which may explain less blood flow after menopause
• a shift in the type and balance of bacteria, which can change vaginal acidity, from more acidic to more alkaline.

What symptoms can I expect?

Many women do not notice any bothersome vaginal changes as they age. There’s also little evidence many of these changes cause vaginal symptoms. For example, there is no direct evidence these changes cause vaginal infection or bleeding in menopausal women.

Some women notice vaginal dryness after menopause, which may be linked to less vaginal secretions. This may lead to pain and discomfort during sex. But it’s not clear how much of this dryness is due to menopause, as younger women also commonly report it. In one study, 47% of sexually active postmenopausal women reported vaginal dryness, as did around 20% of premenopausal women.

Other organs close to the vagina, such as the bladder and urethra, are also affected by the change in hormone levels after menopause. Some women experience recurrent urinary tract infections, which may cause pain (including pain to the side of the body) and irritation. So their symptoms are in fact not coming from the vagina itself but relate to changes in the urinary tract.

Not everyone has the same experience

Women vary in whether they notice vaginal changes and whether they are bothered by these to the same extent. For example, women with vaginal dryness who are not sexually active may not notice the change in vaginal secretions after menopause. However, some women notice severe dryness that affects their daily function and activities.

In fact, researchers globally are taking more notice of women’s experiences of menopause to inform future research. This includes prioritising symptoms that matter to women the most, such as vaginal dryness, discomfort, irritation and pain during sex.

If symptoms bother you

Symptoms such as dryness, irritation, or pain during sex can usually be effectively managed. Lubricants may reduce pain during sex. Vaginal moisturisers may reduce dryness. Both are available over-the-counter at your local pharmacy.

While there are many small clinical trials of individual products, these studies lack the power to demonstrate if they are really effective in improving vaginal symptoms.

In contrast, there is robust evidence that vaginal oestrogen is effective in treating vaginal dryness and reducing pain during sex. It also reduces your chance of recurrent urinary tract infections. You can talk to your doctor about a prescription.

Vaginal oestrogen is usually inserted using an applicator, two to three times a week. Very little is absorbed into the blood stream, it is generally safe but longer-term trials are required to confirm safety in long-term use beyond a year.

Women with a history of breast cancer should see their oncologist to discuss using oestrogen as it may not be suitable for them.

Are there other treatments?

New treatments for vaginal dryness are under investigation. One avenue relates to our growing understanding of how the vaginal microbiome adapts and modifies around changes in circulating and local concentrations of hormones.

For example, a small number of reports show that combining vaginal probiotics with low-dose vaginal oestrogen can improve vaginal symptoms. But more evidence is needed before this is recommended.

Where to from here?

The normal ageing process, as well as menopause, both affect the vagina as we age.

Most women do not have troublesome vaginal symptoms during and after menopause, but for some, these may cause discomfort or distress.

While hormonal treatments such as vaginal oestrogen are available, there is a pressing need for more non-hormonal treatments.

Dr Sianan Healy, from Women’s Health Victoria, contributed to this article.

Louie Ye, Clinical Fellow, Department of Obstetrics and Gynecology, The University of Melbourne and Martha Hickey, Professor of Obstetrics and Gynaecology, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

When spring arrives, so do warnings about thunderstorm asthma. But a decade ago, most of us hadn’t heard of it.

So where did thunderstorm asthma come from? Is it a new phenomenon?

In 2016, the world’s most catastrophic thunderstorm asthma event took Melbourne by surprise. An increase in warnings and monitoring is partly a response to this.

But there are also signs climate change may be exacerbating the likelihood of thunderstorm asthma, with more extreme weather, extended pollen seasons and a rise in Australians reporting hay fever.

A landmark catastrophe

The first time many Australians heard of thunderstorm asthma was in November 2016, when a major event rocked Melbourne.

During a late night storm, an estimated 10,000 people were rushed to hospitals with severe asthma attacks. With thousands of calls on emergency lines, ambulances and emergency departments were unprepared to handle the rapid increase in people needing urgent medical care. Tragically, ten of those people died.

This was the most catastrophic thunderstorm asthma event in recorded history and the first time deaths have ever occurred anywhere in the world.

In response, the Victorian Department of Health implemented initiatives, including public awareness campaigns and improvements to health and emergency services, to be ready for future thunderstorm asthma events.

A network of pollen monitoring stations was also set up across the state to gather data that helps to predict future events.

A problem for decades

While this event was unexpected, it wasn’t the first time we’d had thunderstorm asthma in Australia – we’ve actually known about it for decades.

Melbourne reported its first instance of thunderstorm asthma back in 1984, only a year after this phenomenon was first discovered in Birmingham in the United Kingdom.

Thunderstorm asthma has since been reported in other parts of Australia, including Canberra and New South Wales. But it is still most common in Melbourne. Compared to any other city (or country) the gap is significant: over a quarter of all known events worldwide have occurred in Melbourne.

Why Melbourne?

Melbourne’s location makes it a hotspot for these kinds of events. Winds coming from the north of Melbourne tend to be dry and hot as they come from deserts in the centre of Australia, while winds from the south are cooler as they come from the ocean.

When hot and cool air mix above Melbourne, it creates the perfect conditions for thunderstorms to form.

Northern winds also blow a lot of pollen from farmlands into the city, in particular grass pollen. This is not only the most common cause of seasonal hay fever in Melbourne but also a major trigger of thunderstorm asthma.

Why grass pollen?

There’s a particular reason grass pollen is the main culprit behind thunderstorm asthma in Australia. During storms there is a lot of moisture in the air. Grass pollen will absorb this moisture, making it swell up like a water balloon.

If pollen absorbs too much water whilst airborne, it can burst or “rupture,” releasing hundreds of microscopic particles into the air that can be swept by powerful winds.

Normally, when you breathe in pollen it gets stuck in your upper airway – for example, your nose and throat. This is what causes typical hay fever symptoms such as sneezing or runny nose.

But the microscopic particles released from ruptured grass pollen are much smaller and don’t get stuck as easily in the upper airway. Instead, they can travel deep into your airways until they reach your lungs. This may trigger more severe symptoms, such as wheezing or difficulty breathing, even in people with no prior history of asthma.

So who is at risk?

You might think asthma is the biggest risk factor for thunderstorm asthma. In fact, the biggest risk factor is hay fever.

Up to 99% of patients who went to the emergency department during the Melbourne 2016 event had hay fever, while a majority (60%) had no prior diagnosis of asthma.

Every single person hospitalised was allergic to at least one type of grass pollen. All had a sensitivity to ryegrass.

Is thunderstorm asthma becoming more common?

Thunderstorm asthma events are rare, with just 26 events officially recorded worldwide.

However there is evidence these events could become more frequent and severe in coming years, due to climate change. Higher temperatures and pollution could be making plants produce more pollen and pollen seasons last much longer.

Extreme weather events, including thunderstorms, are also expected to become more common and severe.

In addition, there are signs rates that hay fever may be increasing. The number of Australians reporting allergy symptoms have risen from 15% in 2008 to 24% in 2022. Similar trends in other countries has been linked to climate change.

How can I prepare?

Here are three ways you can reduce your risk of thunderstorm asthma:

• stock up on allergy medication and set up an asthma action plan with your GP
• check daily pollen forecasts for the estimated pollen level and risk of a thunderstorm asthma event in your local area
• on days with high pollen or a high risk of thunderstorm asthma, spend less time outside or wear a surgical face mask to reduce your symptoms.

Kira Morgan Hughes, PhD Candidate in Allergy and Asthma, School of Life and Environmental Sciences, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

While you’re likely familiar with type 1 and type 2 diabetes, you’ve probably heard less about type 1.5 diabetes.

Also known as latent autoimmune diabetes in adults (LADA), type 1.5 diabetes has features of both type 1 and type 2 diabetes.

More people became aware of this condition after Lance Bass, best known for his role in the iconic American pop band NSYNC, recently revealed he has it.

So, what is type 1.5 diabetes? And how is it diagnosed and treated?

There are several types of diabetes

Diabetes mellitus is a group of conditions that arise when the levels of glucose (sugar) in our blood are higher than normal. There are actually more than ten types of diabetes, but the most common are type 1 and type 2.

Type 1 diabetes is an autoimmune condition where the body’s immune system attacks and destroys the cells in the pancreas that make the hormone insulin. This leads to very little or no insulin production.

Insulin is important for moving glucose from the blood into our cells to be used for energy, which is why people with type 1 diabetes need insulin medication daily. Type 1 diabetes usually appears in children or young adults.

Type 2 diabetes is not an autoimmune condition. Rather, it happens when the body’s cells become resistant to insulin over time, and the pancreas is no longer able to make enough insulin to overcome this resistance. Unlike type 1 diabetes, people with type 2 diabetes still produce some insulin.

Type 2 is more common in adults but is increasingly seen in children and young people. Management can include behavioural changes such as nutrition and physical activity, as well as oral medications and insulin therapy.

How does type 1.5 diabetes differ from types 1 and 2?

Like type 1 diabetes, type 1.5 occurs when the immune system attacks the pancreas cells that make insulin. But people with type 1.5 often don’t need insulin immediately because their condition develops more slowly. Most people with type 1.5 diabetes will need to use insulin within five years of diagnosis, while those with type 1 typically require it from diagnosis.

Type 1.5 diabetes is usually diagnosed in people over 30, likely due to the slow progressing nature of the condition. This is older than the typical age for type 1 diabetes but younger than the usual diagnosis age for type 2.

Type 1.5 diabetes shares genetic and autoimmune risk factors with type 1 diabetes such as specific gene variants. However, evidence has also shown it may be influenced by lifestyle factors such as obesity and physical inactivity which are more commonly associated with type 2 diabetes.

What are the symptoms, and how is it treated?

The symptoms of type 1.5 diabetes are highly variable between people. Some have no symptoms at all. But generally, people may experience the following symptoms:

• increased thirst
• frequent urination
• fatigue
• blurred vision
• unintentional weight loss.

Typically, type 1.5 diabetes is initially treated with oral medications to keep blood glucose levels in normal range. Depending on their glucose control and the medication they are using, people with type 1.5 diabetes may need to monitor their blood glucose levels regularly throughout the day.

When average blood glucose levels increase beyond normal range even with oral medications, treatment may progress to insulin. However, there are no universally accepted management or treatment strategies for type 1.5 diabetes.

Type 1.5 diabetes is often misdiagnosed

Lance Bass said he was initially diagnosed with type 2 diabetes, but later learned he actually has type 1.5 diabetes. This is not entirely uncommon. Estimates suggest type 1.5 diabetes is misdiagnosed as type 2 diabetes 5–10% of the time.

There are a few possible reasons for this.

First, accurately diagnosing type 1.5 diabetes, and distinguishing it from other types of diabetes, requires special antibody tests (a type of blood test) to detect autoimmune markers. Not all health-care professionals necessarily order these tests routinely, either due to cost concerns or because they may not consider them.

Second, type 1.5 diabetes is commonly found in adults, so doctors might wrongly assume a person has developed type 2 diabetes, which is more common in this age group (whereas type 1 diabetes usually affects children and young adults).

Third, people with type 1.5 diabetes often initially make enough insulin in the body to manage their blood glucose levels without needing to start insulin medication. This can make their condition appear like type 2 diabetes, where people also produce some insulin.

Finally, because type 1.5 diabetes has symptoms that are similar to type 2 diabetes, it may initially be treated as type 2.

We’re still learning about type 1.5

Compared with type 1 and type 2 diabetes, there has been much less research on how common type 1.5 diabetes is, especially in non-European populations. In 2023, it was estimated type 1.5 diabetes represented 8.9% of all diabetes cases, which is similar to type 1. However, we need more research to get accurate numbers.

Overall, there has been a limited awareness of type 1.5 diabetes and unclear diagnostic criteria which have slowed down our understanding of this condition.

A misdiagnosis can be stressful and confusing. For people with type 1.5 diabetes, being misdiagnosed with type 2 diabetes might mean they don’t get the insulin they need in a timely manner. This can lead to worsening health and a greater likelihood of complications down the road.

Getting the right diagnosis helps people receive the most appropriate treatment, save money, and reduce diabetes distress. If you’re experiencing symptoms you think may indicate diabetes, or feel unsure about a diagnosis you’ve already received, monitor your symptoms and chat with your doctor.

Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University and Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.