If screening shows that you have abnormal cells in your cervix, the doctor or nurse you see in the colposcopy clinic (colposcopist) may recommend that you have them treated. The aim of treatment is to remove or destroy the abnormal cells in your cervix. However, the first step is to be sent for a colposcopy. Treatment may be offered at a first visit to colposcopy. If this is a possibility you will be advised beforehand.
This section covers:
- Types of treatment
- Large loop excision of the transformation zone (LLETZ)
- Cone biopsy
- Straight wire excision of the transformation zone (SWETZ) or needlepoint excision of the transformation zone (NETZ)
- Laser treatments
- Cold coagulation
- Harriet's story
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The treatment you will be offered depends on the type of abnormal cells you have in your cervix (the grade of CIN and/or the presence of CGIN) and how advanced the changes are. Your colposcopist will advise you on the specific treatment you will require during your colposcopy appointment. CIN1 is usually not treated, as these changes often return to normal given time and are not precancerous.
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.
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.
To read more about LLETZ download our information booklet.
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) . 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 .
However, excisions that are deeper than 10 mm or repeated LLETZ procedures may significantly increase the risk of preterm labour, depending on the individual . 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.
A cone of tissue is cut away from your cervix to remove all the abnormal cells. In this procedure the doctor removes a similar sized or slightly larger piece of the cervix than with a LLETZ) biopsy. There is not much variation in the size of a cone biopsy, so if only a small area needs removing it will probably be done using a LLETZ. A cone biopsy allows for the cells at the edges of the specimen to be seen clearly through a microscope ensuring that all of the biopsy can be examined by a histopathologist (an expert in studying diseases by looking at cells).
A cone biopsy is usually carried out under a general anaesthetic, which is where you are asleep (very few cone biopsies are performed under local anaesthetic). A vaginal pack will sometimes be put in place in theatre while you are under anaesthetic. This is like a long bandage that puts pressure on the biopsy site and so helps stop any bleeding (a bit like putting pressure on a cut to stop it bleeding). It will be removed before you go home. Not all health gynae-oncologists use vaginal packs, so please discuss this with your medical team if you have any questions. It is advisable to have some painkillers at home (such as you would take for period pains) as some women experience a deep ache and/or tenderness in their pelvis. It is not unusual to feel tired for a few days or even a week or so following a general anaesthetic.
For more information on the possible side effects after a cone biopsy please visit our information page.
Similar to a cone biopsy these procedures remove a piece of tissue but they use a straight wire or needle diathermy with electricity running through them to cut and seal the tissue, like a LLETZ treatment. The procedures are done in a clinic with local anaesthetic (like a LLETZ) or under general anaesthetic (like a cone biopsy). These treatments are usually done if the abnormal cells are inside the cervical canal or if you have glandular abnormal cells.
A cold probe is used to freeze away the abnormal cells in the cervix. This is sometimes used to treat CIN1.
This is sometimes called laser ablation. Lasers are used to pinpoint and destroy abnormal cells in the cervix. If necessary, a laser can also be used to remove a small piece of the cervix itself. This is called laser excision or laser cone biopsy.
Despite the name of this treatment this procedure involves applying a hot probe to the cervix, which, like a laser, destroys the abnormal cells. This treatment can also be called thermocoagulation.
A local anaesthetic is given before any of the treatments described above except for larger cone biopsies, which may require a general anaesthetic.
Your colposcopist should provide you with additional information on the treatment that you will be having. Remember to ask if you have questions.
Bleeding (at the time of treatment or in the two to three weeks afterwards) or infection (more often 10–14 days after) can occur after treatment for abnormal cells of the cervix. You may experience vaginal discharge or bleeding like the end of a period for two to three weeks after your treatment. However this does vary a lot, for example a few women will have no bleeding at all and some will be bleeding for up to six weeks. After your treatment you may feel some pain, this is because the local anaesthetic used during your treatment will wear off after two to three hours. This pain often feels like cramps that you can have during your period. Some women notice pain more the day after the treatment. Sometimes periods can be irregular or more painful for two to three months after treatment. Always contact your GP or colposcopist if you are experiencing any problems after treatment. There is no reason to put up with discomfort that can easily be treated.
If you are working you might be advised to take a day or two off from work (your colposcopist will let you know if this is necessary). You might need some pain relief after your treatment, the clinic where you had treatment can advise you on this.
Generally, a single, straightforward treatment to the cervix is very unlikely to adversely affect your fertility or your ability to have a normal pregnancy.
In most women, one treatment is enough to completely treat their cervical abnormalites. But between 5 and 15% of women will still be affected by CIN or CGIN after their first treatment. You can find out more on our recurrent cervical abnormalities information page.
"My results came back in around five days which was quite alarming and the letter read that I would need to make an urgent hospital referral due to an abnormal result. I went for a colposcopy examination shortly after and was diagnosed with CIN3 (pre-cancerous cells of the cervix at a high grade level, also known as severe dyskariosis)."
- 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.
- 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.