LLETZ treatment for abnormal cervical cells: what happens and aftercare

Screening looks for HPV and cell changes on the cervix. When a result shows moderate or severe changes, or other worrying features, you are referred for colposcopy, where the cervix is examined under a magnifying microscope. A trust leaflet explains the grades of cervical intraepithelial neoplasia, CIN 1, 2 and 3, according to how much of the thickness of the cervical lining is affected. CIN is not cancer; treatment is aimed at preventing it.

Not everyone with an abnormal result needs treatment. Low-grade changes often settle by themselves and may only be monitored, and the colposcopist decides at the appointment whether the cells look as though they should be removed. LLETZ is also sometimes used to remove tissue for diagnosis when the examination alone is unclear.

You can eat normally because only local anaesthetic is used. One trust leaflet asks you not to use tampons, have sex or swim for four weeks before treatment, and to tell the clinic if you take blood thinners. It also asks that you use reliable contraception because treatment cannot go ahead if you are pregnant, and the clinic may ask you to confirm that your period timing or pregnancy status is known.

Wear something comfortable and consider bringing a sanitary pad, as light bleeding is expected. Many people take simple painkillers beforehand if advised. A friend or relative can come along for support.

You undress from the waist down and lie back with your legs supported. A speculum is gently placed in the vagina and the cervix is examined through the colposcope. The NHS describes an injection of local anaesthetic into the cervix first, so you should not feel pain; you may feel a pinch or a warm rush as it goes in.

A thin wire loop, heated by an electric current, then removes the abnormal area, a piece the NHS compares to the size of a fingernail. The base is sealed with a different instrument to stop bleeding. The treatment takes about 15 minutes, you do not stay in hospital, and you can go home the same day.

The removed tissue goes to the laboratory so that pathologists can confirm what the cells were and whether the edges are clear.

Cramping similar to period pain can last for a day or two, and one leaflet says mild to moderate pain for one to two days is common. Bleeding and discharge are the main effect: the NHS says some people bleed for up to four weeks, while a trust leaflet quotes up to 50% with bleeding or discharge for around 10 days. Neither should be heavy.

Less often, bleeding is heavy enough to need hospital care, infection develops, or the cervix narrows slightly as it heals. Because a loop removes cervical tissue, ask your colposcopist how it might relate to any future pregnancy; none of the pages retrieved for this guide quantify that, so no figure is given here.

The NHS advises avoiding penetrative sex, tampons and vigorous exercise while you heal. The trust leaflet gives four weeks without sex or tampons and two weeks without strenuous exercise, and most people return to work the next day unless the job involves heavy lifting. Use pads, shower rather than soak in the bath, and avoid swimming.

Results usually take around four weeks in one leaflet. A repeat cervical screening test is arranged six months after treatment to check that no abnormal cells or HPV remain, and the same leaflet says that approximately 95% of people need no further treatment. Your results letter will say what happens next.

• Heavy bleeding that soaks pads quickly: contact your GP or NHS 111 the same day.

• A foul-smelling discharge, or a fever.

• Tummy pain that painkillers do not settle.

• Dizziness or collapse with heavy bleeding: call 999.

• What did you see, and which grade do you think it is?

• Do I need treatment today or can we wait?

• How will I get my result, and when?

• Will this treatment affect any pregnancy I plan?

NHS colposcopy follows a national screening programme with set referral and recall arrangements, and treatment is usually offered at the same visit. Private colposcopy can be quicker to arrange; make sure that your results are sent to your screening records and your GP so your recall is not missed.