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Large loop excision of the transformation zone (LLETZ) is a type of surgery that removes a small part of the cervix. It can be used treat cervical cell changes (abnormal cells) or early stage cervical cancer, as well as to diagnose cervical cancer.
This information is written for people having LLETZ for cervical cell changes or cervical cancer. We know that having surgery can be overwhelming, so we hope this page helps you feel prepared. If you need more support, remember that we are here for you in other ways too. You could give us a call on 0808 802 8000 or use one of our other support services.
On this page:
- About intimate examinations >
- Making decisions about treatment >
- What is LLETZ? >
- During LLETZ >
- What can and can't I do after LLETZ? >
- Follow-up after LLETZ >
- Risks of LLETZ >
- More information and support >
About intimate examinations
The nature of gynaecological and obstetric care means that intimate examinations are often necessary. We understand that for some people, particularly those who may have anxiety or who have experienced trauma, physical abuse or sexual violence, such examinations can be very difficult. If you feel uncomfortable, anxious or distressed at any time before, during, or after an examination, please let your healthcare professionals know. If you find this difficult to talk about, you may communicate your feelings in writing.
Your healthcare professionals are there to help and they can offer alternative options and support for you. Remember that you can always ask them to stop at any time and that you are entitled to ask for a chaperone to be present. You can also ask to bring a friend or relative if you wish.
If you find intimate examinations difficult, we are here to support you. You can speak with our volunteers on 0808 802 8000 or you may prefer to contact us online.
Making decisions about treatment
Before you make a decision about treatment, it is important to understand the procedure, including benefits, risks and possible effects. Your colposcopist should explain these to you and give you the chance to ask any questions. You may also want to talk over your options with your family or friends.
It can help to write a list of questions and take it to your appointment. The form below suggests some questions you might like to ask and has space for you to write down any others you think of.
Questions you could ask
- What types of treatment can I have?
- What does the treatment do?
- What could happen if I choose not to have treatment?
- How long will the treatment take?
- Do I need to bring anything to the appointment?
- Will I be able to get home by myself after treatment?
- What physical effects might I experience after treatment?
- What emotional effects might I experience after treatment?
What is LLETZ?
LLETZ is the most common treatment for cervical cell changes, but it can also be used to treat early stage cervical cancer. It uses a thin wire loop with an electrical current to remove the affected area of the cervix.
Your appointment
Your appointment will happen in a colposcopy clinic at a hospital. You usually have LLETZ as an outpatient. This means you have it in a hospital examination room, but can go home afterwards.
You usually have a local anaesthetic for LLETZ. But you can choose to have it done under general anaesthetic, where you are asleep. If you would prefer this, talk to your colposcopist about the risks and benefits before your appointment.
The hospital wants to keep you and their staff protected from COVID-19 (coronavirus), so they will be following government guidance on social distancing and using appropriate personal protective equipment (PPE), including masks, gloves and aprons. You will also need to wear a face covering while in the hospital.
If you take blood thinning medication or have a condition that affects your blood, it is important to tell your colposcopist before your appointment. You may have a higher risk of bleeding after the treatment.
LLETZ treatment
During LLETZ
You will have LLETZ lying on your back on an examination couch. The examination couch is adjustable and hoists are usually available if you need assistance.
Preparing for treatment
Like during cervical screening, your colposcopist will gently put a clean speculum into your vagina. Speculums come in different sizes so, if you find the standard size uncomfortable or painful, you can ask for a smaller one.
Your colposcopist will inject a local anaesthetic into your cervix. This means you are awake, but the area that needs treating is numb (you can’t feel it). The injection might sting for a short time and you may be aware of your heart beating faster. This feeling should pass within a couple of minutes.
You may also have a sticky pad put onto on your leg. This makes sure the electric current in the wire loop doesn’t burn you.
Before starting the treatment, your colposcopist will touch your cervix to check it is numb.
Having the treatment
Once your cervix is numb, your colposcopist uses the loop to remove the area of your cervix that has cancer cells. It is normal to notice a slight burning smell and hear a noise like a soft vacuum cleaner.
The loop cuts the tissue and then another small instrument is used to seal the cut. This should not be painful, but you may feel some pressure. The treatment usually takes less than 2 minutes.
The cells and tissue that has been removed is sent to a laboratory. They will test it to check whether:
- the cell changes have been completely removed
- the cervical cancer has been completely removed.
This is done by testing for an ‘edge’ of healthy cells around the area that was removed. This is sometimes called having clear margins. They will also check what type of cervical cell changes or cervical cancer you had.
After the treatment
Once the anaesthetic has worn off, you may have some bleeding. Your colposcopist should offer you a period pad to use, but you might like to bring your own. Do not use tampons or menstrual cups that you put into your vagina.
