What is a LLETZ Procedure?
A LLETZ (Large Loop Excision of the Transformation Zone), also known as LEEP (Loop Electrical Excision Procedure) or a loop diathermy procedure, is most commonly performed under a local anaesthetic to remove abnormal cells from the cervix (neck of the womb). A cold knife cone biopsy is sometimes performed instead of a LLETZ procedure to remove abnormal cells, depending on the nature or type of cells seen. Your doctor will guide you as to the best option for your situation.
These procedures may be performed under a general anaesthetic and your specialist will guide you to the best option after a detailed discussion with you. Only if observation and close monitoring is not in your best interests is treatment recommended, as in many young women with early precancer changes (Cervical Intraepithelial Neoplasia CIN1 or focal CIN2), the body heals itself, getting rid of the HPV over time, thus avoiding treatment to the cervix.
Are there any risks with the treatment?
A LLETZ procedure is very safe but as with any operative procedure there are some small risks. The procedure is only offered if it is thought to be in your best interests. The small risks include a 1 in 100 risk of heavy bleeding, or infection and a 5 in 100 risk of needing further treatment because of persistent abnormal cells or new abnormal cells developing in the future. There is no real risk to fertility.
There is a very small increased risk of preterm labour (babies born before 37 weeks gestation) or needing a stitch in the cervix (cervical cerclage) as a result of weakness of the neck of the womb after treatment to the cervix. There is also a small chance that the cervix may not dilate as it should during labour (cervical dystocia) and a caesarean section may be indicated in such situations. These risks are slightly more common with cold knife cone biopsy.
Depending on the results of the cells removed from the cervix and the amount of tissue removed from the cervix, you may be advised to inform your obstetrician so that you can be monitored during pregnancy and the length of your cervix measured by regular ultrasound scans to watch for any potential weakness developing. Recently, there has been some concern about sexual orgasm being affected after treatment.
This is very uncommon and as mentioned, treatment is only offered when the benefits outweigh the risks. In my 30 years of practice as a gynaecologist, this has not been an issue for my patients who I have been following up for a while. However, I must stress all these risks are very small and should not deter from having necessary treatment.
Most women feel fine after having treatment to the cervix, but a few may feel the need to go home and rest. Either way, it is recommended you don’t plan to do anything else that day.
You may have some period type pains for the rest of the day once the anaesthetic has worn off, and it seems that having pain seems to be more likely in women who haven’t had children. You may take your normal painkillers or paracetamol.
Bleeding and Discharge
You should expect to have some bleeding or discharge after this procedure, sometimes up to 3-4 weeks, with the amount varying depending partly on the type of treatment you have had. Some women have none. The bleeding may stop after a few days but start again 10-14 days later. This is the scab coming away and nothing to worry about. It will stop eventually.
You may also notice that your next period may be slightly heavier than normal, and again, this is nothing to worry about. If you are on the contraceptive pill, I recommend that you take the pill back to back for a couple of months to avoid the heavier period if you so wish. This is safe to do.
If you start to bleed very heavily, you should seek urgent medical advice. You should have a contact number after your procedure.
Infection can occur occasionally, but to minimise this, do not use tampons or have sex for four weeks after the procedure. Heavy exercise and swimming are also not recommended for three weeks.
If you develop an infection (pain, high temperature, unpleasant smell and/or generally feeling unwell) you will need to seek medical advice urgently.
Sex: Avoid sexual intercourse for 3-4 weeks to avoid disturbing the healing wound and reduce risk of infection.
Driving: You should be able to drive when you feel comfortable. You should wait for at least 24 hours after a general anaesthetic.
You will be written to with the results of the treatment. Further follow up and management will be dependent upon the results of the LLETZ, but usually involves a repeat smear at six months known as Test Of Cure (TOC) to see if you are now clear of the high risk strains of the HPV virus, the results of which will determine your continuing follow-up.
Dr Nitu Bajekal FRCOG Dip IBLM
Consultant Gynaecologist and Women’s Health Expert
Lifestyle Medicine Physician
Updated January 2020