LLETZ? What to expect afterwards

Around 220,000 women a year are diagnosed with a cervical abnormality. One of the most common treatments that women receive following diagnosis is a loop biopsy, usually called LLETZ, which stands for large loop excision of the transformation zone, or LEEP, which stands for loop electrosurgical excision procedure.

In this blog, Jill Fozzard, Nurse Colposcopist at the Royal Victoria Hospital and panellist on the Jo’s Cervical Cancer Trust Ask the Expert service, talks through what happens after a loop biopsy to answer some of the most common questions and concerns that the charity receives through its support services.

Will I bleed after LLETZ/LEEP?

You will not usually have any bleeding immediately after a loop biopsy of the cervix. The local anaesthetic used to numb your cervix helps to stop this, which means you can usually carry on with your normal day-to-day activities, such as going to work or shopping. However, it is best to avoid heavy exercise, like a gym workout or exercise class, for 48 hours to prevent heavy bleeding. It is important to remember that a loop biopsy can be an emotionally draining experience, so some women choose to have the rest of the day off and take it easy at home.

The local anaesthetic wears off during the day, so you may experience some discomfort in your lower abdomen, almost like period cramps. This is completely normal and you can take some painkillers as you would normally for pain relief, such as paracetamol or Ibuprofen. You may start to notice some light fresh bleeding which may get heavier over the next few days – again this is absolutely normal.

In the unlikely event that you bleed constantly and are soaking more than two pads every hour, you need to seek medical advice. Your colposcopist will have given you the contact details of who to call should this happen.

Very occasionally, women may experience the bleeding becoming light and then getting much heavier again over the following weeks. It is rare for this to happen, but if it does, it’s important that you know what to do. Contact your colposcopy department and if they’re closed please contact your GP or A&E department as you may need some treatment to stop the bleeding.

Your next period may be heavier than normal and have some clots, which is perfectly normal. The most common effect is to have a lot of brown watery discharge, which may last for several weeks. Some women experience this for between 2 to 4 weeks, but for some women it is longer and can last up to 6 weeks. Again, this is normal. If the discharge develops an unusual smell or you feel unwell with a fever, you may have an infection and we would advise you to visit your GP. If you do have an infection, it is easily treated with a short course of antibiotics.

Very rarely, the colposcopist may need to pack the site of the biopsy with a clotting agent. Usually this is absorbed, but occasionally it may be passed as a clot. This is normal and it does not mean that something was left inside the vagina by mistake.

What should I avoid after LLETZ/LEEP?

There are some particular things to avoid after a loop biopsy to prevent infection and to allow the cervix to heal:

• Avoid taking a bath for 24 hours
• Avoid penetrative vaginal sex for four weeks
• Bacteria exist in the mouth as normal flora, which are harmless but may cause problems if they come into contact with an open wound so oral sex is best avoided for four weeks to allow the cervix to heal fully. Following smaller punch biopsies, avoid oral sex for up to two weeks
• Do not use tampons, vaginal creams or pessaries for four weeks
• Avoid swimming, including the use of hot tubs and Jacuzzis, while you experience brown discharge.

How quickly will I recover after LLETZ/LEEP?

Following a loop biopsy most women recover very quickly, however some women may experience a range of different symptoms that may not ‘fit’ exactly into the information given above. If something does not feel right to you or you feel unwell please just give your colposcopy unit or GP a call, after all you know yourself and your body best.

More information and support

If you are still concerned about anything after reading this blog and would like some further information, you can contact the Jo’s Cervical Cancer Trust’s Helpline on 0808 802 8000 or use the Ask the Expert service.