Large loop excision of the transformation zone (LLETZ)

The LLETZ procedure, which is also known as loop electrosurgical excision procedure (LEEP), diathermy loop biopsy or just a loop, uses a small wire loop with an electrical current running through it to cut away the affected area of tissue and seal the wound at the same time. The procedure is usually carried out under local anaesthetic, where just the area they are treating is made numb but you are still awake. The advantage of this treatment is that the cells are removed rather than destroyed, so the tissue can be sent for further tests to confirm the extent of the cell changes and make sure the whole area of your cervix that contains the abnormal cells has been removed. 

LLETZ

Side effects/complications after LLETZ

After a LLETZ treatment you can usually expect some bleeding and discharge for about three to four weeks. In order to help avoid any possible infections it is recommended that you only use sanitary towels during this time, avoiding tampons, sex and swimming, until any discharge has stopped and any bleeding has settled. Every person’s experience is different, so the amount and colour of any bleeding/discharge can vary a lot depending on how quickly the person heals, the size of the area treated and the treatment method used. Some women start to get bleeding or discharge from the day the treatment is performed and for other women this is very light or absent during the first week or so. 

After treatment what is know as a soft healing scab forms on the cervix. Over time this slowly dissolves away, which is what often causes the discharge and some bleeding. This can vary a lot from woman to woman. The blood can be red or brown in colour and it can vary in heaviness from light spotting to slightly heavier bleeding. Sometimes the discharge can be yellowy in colour, and it can be heavy or watery. Some women find that their next monthly period comes slightly earlier than normal and it may be slightly heavier. This is thought to be caused by the increased blood supply around this area.

All of the above symptoms are very normal after a LLETZ procedure. However, if the bleeding seems particularly heavy (eg. your sanitary towels are soaking every hour) or if the discharge smells really offensive and/or you feel unwell (which could be a sign of infection) you should contact a health care professional. This could be your colposcopy clinic or your GP, or any other health care professional you feel like talking to about this. There will be a specialist nurse in your colposcopy clinic who will be able to address any queries you have. 

Recent research has looked at the risk of preterm labour (giving birth before 37 weeks of pregnancy) for women who have large loop excision of the transformation zone (LLETZ) [1][2]. This has been found to be linked to how deep the excision (area of tissue that is remove) is, which depends on how large the area of abnormalities is. The research shows that if the LLETZ excision is less than 10 mm deep, the risk of preterm labour is not significantly higher [1][2].

However, excisions that are deeper than 10 mm or repeated LLETZ procedures may significantly increase the risk of preterm labour, depending on the individual [2]. This is because deeper excisions remove more of the cervix, which reduces its ability to perform its function during pregnancy – which is to help keep the foetus in the uterus until birth. Each woman's cervix is different; some are shorter than others, which means that there are no set rules about the effect LLETZ treatment might have on future pregnancy.

If you are currently pregnant or are thinking about getting pregnant in the future, and have concerns about a previous LLETZ, please raise this with your care team. They will be able to offer advice and reassure you. If you have had a deep excision, or have had repeated LLETZ procedures they wish to put a stitch, called a cervical stich, in your remaining cervix to support it during any future pregnancies.

To read more about LLETZ, download our A5 LLETZ Information Booklet.

For support, call our helpline on 0808 802 8000.

Joanna’s story

Joanna talks about her experience with the LLETZ procedure and getting diagnosed with cervical cancer:

 ‘Luckily, colposcopy and treatment weren't as bad as I imagined; the LLETZ hurt a little bit when they put the local anaesthetic in but that was about it. The nurse was fantastic too, squeezing my hand throughout and really calming me down.’

‘At the point of them actually saying the word 'cancer' I just didn't know how to react and just sat there. I had always been under the impression that the LLETZ treatment would get rid of the abnormal cells and yet I was sitting there being told I had cervical cancer.’

Read more of Joanna’s story.

 

Natalie’s story

While sharing her cancer story with us, Natalie describes the recovery after her treatments:

‘After both the LLETZ and the cone biopsy it was only a few weeks recovery period really. So I was quite lucky to get up and running.’

Watch more of Natalie’s story or visit our cancer stories information page to hear about other women’s experiences.

 

References

  1. Castanon A et al., 2012. Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England: retrospective-prospective cohort study. British Medical Journal 345, e5174.
  2. Castanon A et al, 2014. Risk of preterm delivery with increasing depth of excision for cervical intraepithelial neoplasia in England: nested case-control study. British Medical Journal 349, g6223.
Date last updated: 
10 Mar 2017
Date due for review: 
11 Jul 2019

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