LLETZ

LLETZ stands for large loop excision of the transformation zone. It's also known as loop electrosurgical excision (LEEP) or loop diathermy.

Your colposcopist uses a thin wire loop to remove the transformation zone of the cervix. The wire has an electrical current running through it, which cuts the tissue and seals the wound at the same time.

The transformation zone is the area around the opening of the cervix.

LLETZ is an outpatient treatment and takes up to 15 minutes. You usually have it under local anaesthetic.

Why you might have LLETZ

LLETZ is a treatment for abnormal cervical cells picked up through cervical screening. You might also have it to help diagnose cervical cancer.

Preparing for LLETZ

• Before your appointment, let the colposcopy clinic know if you are taking blood thinning medication or have a condition that affects your blood.

• Eat and drink as normal before your appointment.

• You may have sex in the time leading up to your appointment unless you have a coil fitted. With a coil avoid sex or use barrier contraception such as condoms for the 7 days before your appointment. This is in case the coil needs to be removed.

• Bring a list of your medications to your appointment and let the colposcopist know about your medical history or any allergies.

• Make a note of when you had your last period.

• Remove any jewellery below the waist, such as a belly button or vaginal piercing at home.

• You may have some vaginal discharge after the pocedure. You will be provided with a sanitary towel, but bring your own if you prefer.

• You can bring someone with you in case you're not feeling well after the appointment.

• Some travel insurance companies will not provide you with health insurance following this procedure. So, try to arrange your appointment after returning from holiday or flying, or wait at least 4 weeks after the treatment.

What happens?

Having LLETZ can feel embarrassing and distressing for some people. But remember, the colposcopist is trained to do this professionally. You can stop the examination at any point if you feel overwhelmed or too uncomfortable.

The colposcopist will:

• explain why you need the procedure

• explain what they are going to do

• get your permission to do it

At the colposcopy clinic, your nurse asks you to undress from the waist down and lie on your back on the examination couch. They give you a sheet to cover yourself. Your legs are supported by 2 leg rests.

Your colposcopist gently puts a medical instrument called a speculum into your vagina to hold it open (like when you have a cervical screening test). They look through the colposcope to examine your cervix.

They inject some local anaesthetic into your cervix. This might sting briefly, and your heart might beat faster. This will pass within a few minutes. The local anaesthetic numbs the area. Your colposcopist uses the loop to remove the area of tissue with the abnormal cells. This is not painful, but you may feel some pressure. It is also normal to notice a slight burning smell.

Your colposcopist removes the speculum, and you can get dressed when ready.

After LLETZ

You can go home as soon as the LLETZ is over.

Some people feel dizzy or faint when they get up after the procedure. The nurse will ask you to lie down if you feel like this. They will monitor you until you have recovered and are ready to go home.

You might have some bleeding after the procedure. You will be provided with a sanitary towel, but bring your own if you prefer.

Possible risks

Bleeding

You might have bleeding lasting between 2 days to up to 4 weeks after having LLETZ.

Any bleeding is usually like a period but may be slightly heavier than your normal period. Bleeding might get heavier around 10 days after treatment. This is normal and a sign that the area of treatment is healing. Your first period after treatment might also be heavier and not at the same time as your regular cycle.

It is important to act if bleeding is soaking through your sanitary towel every hour. Call the number your colposcopy team gave, call 111 out of hours or go to accident and emergency (A&E).

Pain

You may have pain lasting between 2 days and up to 4 weeks after treatment. Pain should not be too severe. It might feel like a cramping pain, similar to having a period. Ask the colposcopist about what pain medication you can take.

If you are in a lot of pain or if it lasts longer than 3 months, contact your GP.

Infection

You may see changes to your vaginal discharge for about 4 weeks. Straight after treatment, it may be watery or brown.

After 10 days, it may change to a coffee granule-like vaginal discharge. This is normal and a sign that the area of treatment is healing.

Some people might get an infection. Talk to your GP if your vaginal discharge smells unpleasant or is a yellow or green colour. This might be an infection, and you will need antibiotics.

To reduce infection during this time and for the next 4 weeks, you shouldn't:

• use tampons or menstrual cups

• have penetrative sex, including using fingers, tongues or any other objects

• do heavy exercise such as running or gym workouts that cause you to sweat

• swim

• take long baths – you may shower

Giving birth before 37 weeks (premature birth)

About 2 out of every 100 (2%) people who become pregnant at any time after LLETZ will give birth before 37 weeks (prematurely). This is because of the treatment.

Giving birth prematurely is more likely if you:

• have had LLETZ more than once

• had more than 10mm of your cervix removed - most LLETZ treatments remove less than 10mm of your cervix

Tell your doctor or midwife you have had LLETZ if you become pregnant after the treatment. They can refer you to a specialist in preventing preterm birth.

Narrowing or closing of the opening of the cervix (cervical stenosis)

The cervix's opening (the os) can narrow or close and become scarred after LLETZ. This is called cervical stenosis. If this happens, the canal between the womb and vagina may become partly or fully blocked. This happens in about 2 to 14 out of every 100 (2% to 14%) people.

Cervical stenosis is more likely to happen if you have had:

• the menopause

• more than one treatment

• treatment that removed a large area of your cervix

Cervical stenosis does not always cause symptoms. If you have periods, you may find that they become irregular or painful. Getting pregnant might be harder because the sperm may not be able to reach the womb.

Doing cervical screening in the future may also be more difficult, but you can be referred to colposcopy if this happens.

Cervical dilators can sometimes be used to help widen the cervix. 

Getting your results

Before you leave hospital make sure you know how you will be given the results. You may be asked to return to the hospital for an outpatient appointment to get the results. Or the results may be sent in the post.