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Monitoring cervical cell changes

Your colposcopy team may suggest cervical cell changes (abnormal cells) are monitored, instead of treated. This means you would be invited back for follow up appointments at your GP surgery or the colposcopy department to check the cell changes have cleared or got better. 

On this page:

What is monitoring?

Monitoring is when cell changes are not treated. Instead, you are invited back for an appointment at your GP surgery or the colposcopy appointment department. This is to check the cell changes have cleared or got better, and that they not getting worse (progressing). 

Monitoring is sometimes recommended instead of or as another option to treatment. The recommendations your colposcopy team make will be based on:

  • the type and grade of cell changes
  • your personal situation – for example, age and medical history.

Monitoring is usually only recommended for:

  • CIN1
  • CIN2 , in some cases.

What happens at monitoring appointments?

At your monitoring appointment, you will have follow up tests. These tests will depend on the type of cell changes you have.

Monitoring for CIN1

Most cases of CIN1 are monitored rather than treated . This is because it is more likely these cell changes will stay the same or go back to ‘normal’, rather than progress to a higher grade or cervical cancer.

Read about the progression and regression of cell changes >

You will be invited for a monitoring appointment 1 year after your colposcopy. This is usually at your GP surgery or at the colposcopy department in the hospital. You will have cervical screening (a smear test), which will check for high-risk HPV:

  • If you don’t have HPV – You will be invited back for cervical screening in 3 years, whatever your age.
  • If you have HPV – Your sample will be checked for cell changes. It may show you no longer have cell changes, but you should still be invited back for colposcopy. This is just to make sure the cell changes are definitely gone. 

Remember that your colposcopy team will make recommendations based on your personal situation. They will only recommend monitoring if it is safe for you. 

Monitoring for CIN2

Your colposcopy team may recommend that you are monitored for CIN2. This is sometimes called ‘surveillance’ or ‘conservative management’. Monitoring is offered because many cases of CIN2 will stay the same or go back to ‘normal’, rather than progress to a higher grade or cervical cancer .

Read about the progression and regression of cell changes >

Current health guidelines on monitoring CIN2 says it can be offered if:

  • colposcopy has shown CIN3 or cervical cancer is not present
  • the CIN2 is in less than half of the cervix
  • a group of doctors and nurses (multidisciplinary team or MDT) have talked about your situation and agreed on recommendations
  • you are comfortable with the monitoring plan, including understanding that CIN2 can sometimes take 2 years to regress .

You will be invited for a monitoring appointment 6 months after your colposcopy. This will be at the colposcopy department in the hospital. It will usually involve a visual examination and a biopsy, like your original colposcopy appointment. You may also have a cervical screening test:

  • If the CIN2 is gone or has regressed – What happens next will depend on your exact result. Your colposcopy team will let you know what other appointments you need.
  • If the CIN2 has stayed the same – You will be invited back to colposcopy in 6 months. 
  • If the CIN2 has progressed – CIN2 may progress to CIN3. If this happens, your colposcopy team will offer you treatment.

If CIN2 has stayed the same for 2 years, your colposcopy team will offer you treatment. It is important you feel comfortable and involved in any decisions, so try to ask all the questions you need.

Read about treatment for cell changes >

Benefits and risks of monitoring

Your colposcopy team should talk through all options for managing cell changes with you, including monitoring or treating. As part of that conversation, they should explain the risks and benefits of the different options. 

The benefits of monitoring: 

  • You do not have to have treatment. This means you avoid any physical or emotional impacts of treatment that some people experience.  

The possible risks of monitoring:

  • Cell changes may progress to a higher grade. Going to regular monitoring appointments helps to reduce this risk. 
  • You have to go to more GP or colposcopy appointments. We know that, for some people, this can be difficult or distressing. We have tips to make gynaecological appointments better that may help >

It is important to understand the benefits and risks of any options for managing cell changes, and that you feel comfortable with your decision. Your colposcopy team are the best people to talk to as they know your personal situation, but you may also find it helpful to talk with others on our Forum or call our Helpline on 0808 802 8000.

Monitoring FAQs

Your colposcopy team should talk through all your options and involve you in decisions about whether to monitor or treat cell changes. If they recommend one option over another, it should be because research and your personal situation means that option would have a better outcome for you. 

If you have questions about monitoring in your situation, your colposcopy team will be able to have that conversation with you.

The best thing you can do is attend your monitoring appointments. By doing this, you will be getting the best care and your colposcopy team will be able to manage your cell changes properly.

If you smoke, you may want to try to stop. Cell changes are more likely to progress in those who smoke because: 

  • Smoking weakens your immune system, so your body is less able to get rid of high-risk HPV.  
  • Nicotine and the chemicals in cigarette smoke can damage your cells. This makes cell changes more likely to develop or progress. 

The exact risk depends on how long you have smoked for and the number of cigarettes you smoke per day. If you would like to stop smoking, the NHS has programmes to support you:

How we can help

It may feel difficult to decide how to manage cell changes. Remember that your colposcopy team are there to support you and answer any questions. It is important to take the time you need to make your decision. 

If you need some extra support, you can give our free Helpline a call on 0808 802 8000. Our trained volunteers can talk through the different options or simply listen to how you’re feeling.

Check the opening hours > 

Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. You can read through the messages or post your own – whichever feels most comfortable.

Join our Forum >

If you have general questions about monitoring cell changes, our panel of medical experts may be able to help. They can’t give you answers about your individual situation or health – it’s best to speak with your colposcopy team for that.

Use our Ask the Expert service >

Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it. 

References

  • Public Health England (2021). 4. Colposcopic diagnosis, treatment and follow up. Cervical screening: programme and colposcopy management. Web: https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/3-colposcopic-diagnosis-treatment-and-follow-up. Accessed November 2021.
  • Public Health England (2021). 2. Management and referral guidelines for colposcopy. Cervical screening: programme and colposcopy management. Web: https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/2-providing-a-quality-colposcopy-clinic. Accessed 
  • Tainio K et al (2018). Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis. BMJ. 360:k499.
  • Public Health England (2021). 4. Colposcopic diagnosis, treatment and follow up. Cervical screening: programme and colposcopy management. Web: https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/3-colposcopic-diagnosis-treatment-and-follow-up. Accessed November 2021.
  • Guillaud M et al (2014). Evaluation of HPV Infection and Smoking Status Impacts on Cell Proliferation in Epithelial Layers of Cervical Neoplasia. PLOS One.
  • Matsumoto K et al (2010). Tobacco smoking and regression of low-grade cervical abnormalities. JCA: Cancer Science. 101;9.pPp.2065-2073.

 

 

We write our information based on literature searches and expert review. For more information about the references we used, please contact [email protected] 

Read more about how we research and write our information >

Date last updated: 
14 Jan 2022
Date due for review: 
14 Jan 2025