In an interview by the women’s health magazine “Frauengesundheit”, Silvia Gamper highlights her experience with postmenopausal bleeding, which raised concerns about endometrial carcinoma. Upon being advised to undergo invasive procedures like hysteroscopy and curettage under general anesthesia, she sought alternatives due to the physical and emotional burden.

She researched and discovered an innovative test developed by Prof. Widschwendter at the University College London. This test, similar to a painless PAP smear, provided a reliable assessment, confirming that her bleeding was unrelated to cancer.

She emphasizes the importance of promptly addressing abnormal bleeding and advocates for innovative diagnostic methods to reduce unnecessary invasive procedures. Gamper hopes such advancements become widely accessible to improve women’s healthcare.

I wanted a quick, safe answer without surgery – the test was exactly what I was looking for.

Postmenopausal Bleeding: Precise Diagnosis Instead of Stressful Procedures

Postmenopausal bleeding is a key symptom of widespread endometrial carcinoma. The process of clarification and the path to the correct diagnosis is often burdensome. Patient Silvia Gamper successfully sought alternatives.

How did this suspicion of endometrial carcinoma manifest itself?

I was surprised by postmenopausal bleeding in April 2023. Since I had often heard or read that bleeding occurring more than twelve months after the last menstrual period could be a sign of cancer, I was quite alarmed. I contacted my gynecologist and got an appointment within a few days. An ultrasound of my uterine lining showed irregularities and thickening. Combined with the bleeding, my doctor determined that further clarification was necessary: dilation of the cervical canal, hysteroscopy, and curettage of the uterus under general anesthesia. The thought was very distressing. However, I quickly scheduled and received a hospital appointment for safety.

Did you have the opportunity to discuss the diagnosis with your doctor beforehand?

Instinctively, I felt that I didn’t want to undergo this procedure and sought to avoid it. During my conversation with my gynecologist, I considered what else could be the cause. I told her I was suffering from a calcified shoulder and had taken many, unfortunately, ineffective medications. When my doctor asked if I had also been treated with cortisone and I confirmed, she said: “Well, there we have it.” I looked up the package insert to verify and convince myself. The specialist literature also discusses bleeding as a side effect of cortisone in connection with orthopedic complaints extensively.

What reasons did you have for opposing curettage?

I wasn’t particularly afraid of the procedure or anesthesia. If it were truly necessary, I would have done it. But after my gynecologist specifically addressed the cortisone treatment and I confirmed it through my research, the high effort and stress of the procedure seemed hard to justify given its likely limited benefits. An invasive procedure under general anesthesia seemed excessive to clarify what was probably harmless, temporary bleeding. That was a hurdle for me. At the same time, I wanted the bleeding to be professionally clarified. Early detection and prompt treatment are critical for uterine cancer. Although the bleeding stopped in the meantime, it lingered in my mind. Ignoring medical advice wasn’t a solution.

How did you experience this situation at the time?

It was stressful, but I could speak openly about it and exchange ideas within my social circle. The understanding I received from family and friends was comforting, though they couldn’t offer professional advice. A friend mentioned that his mother had died of endometrial carcinoma, making my situation more real and impactful. While I have no genetic predisposition, considering my age, I am in the risk group.

Was this the point when you started researching?

I had a hospital appointment for surgery in about two weeks. The pre-examinations were completed to avoid delays and prepare for surgery if no alternative arose. I pointed out the cortisone use, but they explained that per guidelines, hysteroscopy and curettage were necessary. My dilemma remained unresolved. I thought there must be an alternative – something more precise than an ultrasound, perhaps an MRI or blood test. After researching, I found Professor Widschwendter and his team at the University College London, who were developing such a test. Although it wasn’t on the market in spring 2023, I contacted Prof. Widschwendter directly. He was kind and understanding as I explained my situation. He arranged access to the test through the responsible laboratory.

How was the test conducted?

Prof. Widschwendter provided information for my gynecologist, and we discussed whether she could perform the test. She was immediately supportive. The lab sent a test kit to my doctor, and the procedure was like a PAP smear – painless, straightforward, and took just seconds. The sample was sent to the lab, and within days, I discussed the results with my doctor: the test was unequivocally negative. With the bleeding also stopped, we agreed on regular ultrasound checks. My uterine lining has since returned to normal, and there’s been no further bleeding. Everything resolved positively, and I continue with regular preventive examinations.

How did you feel while waiting for the test results?

It felt like Schrödinger’s Cat – a state suspended between two extremes: either the cat is dead or alive, and similarly, either I’m healthy or have cancer. The test result confirmed my suspicions, providing immense relief. Even while the outcome was uncertain, I felt good about the test, as it offered a quick and reliable clarification without surgery. I believe I would have opted for regular ultrasounds over surgery even without the test.

What advice would you give women in similar situations?

The most important thing is to promptly clarify any abnormal or postmenopausal bleeding. Innovations in women’s health often take a long time to become established. The PAP test revolutionized women’s health but took nearly 40 years to achieve widespread adoption. I’m thrilled that the Austrian Society for Gynecology and Obstetrics (OEGGG) recognized Dr. Chiara Herzog’s contribution to the test development with the AGO Young Scientist Award. I hope this test becomes widely available sooner, enabling women to receive reliable diagnoses without unnecessary procedures.