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Treating cervical cell changes

Cervical cell changes (abnormal cells) may need treatment. Common treatments include LLETZ and cone biopsy. 

We know being told you have cell changes that need treatment can be hard. We hope the information on this page helps prepare you and answers some questions. We also have information about:

Remember, our support services are here for you. Sometimes it can help to hear from someone who has been through a similar experience, so you may want to call our Helpline on 0808 802 8000 or join our Forum. 

Get support >

What treatment will I have?

You may have treatment at your first colposcopy appointment. If you didn’t have it at your first colposcopy appointment, you should be invited for it within 4 to 6 weeks. Your colposcopist should be able to help with any questions about when you will have treatment.

Your treatment will depend on the type and grade of the cell changes. Common treatments for cell changes are:

Read more about CIN and CGIN >

Making treatment decisions

Deciding on treatment can be a really personal thing, so before making decisions make sure you understand:

  • why you are being offered treatment
  • what the treatment involves
  • any possible risks or side effects.

Your colposcopist should explain all of this. If they don’t, or you feel like you need more information, you can take the time to gather everything you need. 

You may also feel emotionally affected by having treatment, whether that is relief, anxiety, confusion or a mix of these and more. All of your feelings, including any we don’t mention here, are valid. Many people feel this way  and it’s important to get the support you need. Talking to your colposcopist may help. 

We can also give you support, from chatting through how you’re feeling to answering general questions about cell changes and treatment.

Get support >  

No treatment

If you have CIN1, your colposcopist may suggest you don't have treatment. This is because your immune system may get rid of the high-risk HPV and the cervical cell changes may go away without needing treatment. We know this may sound worrying, but your colposcopist would only suggest this if it was safe based on your individual medical history and characteristics. 

If you don't have treatment and have CIN1, you should have a follow up appointment in 12 months. This will usually happen at your GP surgery.

No treatment may also be suggested for CIN2, which is sometimes called conservative management. Again, your colposcopist would only suggest this if it was safe for you. If this happens, you should have a follow up appointment in 6 months at colposcopy.  

Large loop excision of the transformation zone (LLETZ)

LLETZ is the most common treatment for removing cell changes. It uses a thin wire loop with an electrical current to remove the area of the cervix where there are cell changes.

Where will I have LLETZ? 

Your appointment will happen in the coloscopy clinic at a hospital. You are an outpatient, which means you can go home afterwards.

The hospital wants to keep you and your healthcare team protected from coronavirus, so they will be following government guidance on social distancing and using appropriate personal protective equipment (PPE). 

Read more about what to expect at the hospital >

What happens during LLETZ?

Like during cervical screening (a smear test), your colposcopist will gently put a new, clean speculum into your vagina. 

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. 

Your colposcopist may also put a sticky pad on your leg. This makes sure the electric current doesn’t shock you or the colposcopist. 

Once your cervix is numb, your colposcopist removes the area of the tissue with cell changes with the loop. It’s normal to notice a slight burning smell and hear a noise like a soft vacuum cleaner. The loop cuts the tissue and seals the cut at the same time. This should not be painful, but you may feel some pressure.

The removed area is sent to a laboratory to test:

  • the extent of the cell changes
  • whether all of the cell changes have been removed (there are clear margins).

If you have CGIN

If you have cell changes inside your cervical canal (CGIN), you may need a deeper treatment to diagnose and remove abnormal cells there. You may be offered:

  • straight wire excision of the transformation zone (SWETZ)
  • needlepoint excision of the transformation zone (NETZ)
  • cone biopsy. 

SWETZ and NETZ are similar to LLETZ, but the thin wire is straight, rather than a loop. Depending on the results and your situation, you may need another excision or be offered a hysterectomy. If this happens, your colposcopist will talk through all the options with you.

LLETZ treatment

An illustration showing the parts of the cervix removed during LLETZ treatment.  

Cone biopsy

A cone biopsy is a small surgery that will remove a cone-shaped piece of tissue from your cervix. 

A cone biopsy is done under general anaesthetic, which means you are asleep and won’t feel anything. The treatment takes about 15 minutes. Afterwards, you may have to stay in hospital overnight.

A cone biopsy can be done with a:

  • scalpel (surgical knife)
  • laser 
  • thin wire loop with an electric current running through it.

After a cone biopsy, your doctor may put a small pack of gauze (like a tampon) in your vagina to stop bleeding. You may also have a tube (a catheter) to drain urine from the bladder while the gauze pack is in place. The gauze and tube are usually removed within 8 hours. Once they have been removed, you can go home.

The cone-shaped piece of tissue is sent to a laboratory to test:

  • the extent of the cell changes
  • whether all of the cell changes have been removed (there are clear margins).

A cone biopsy

  

Other treatments for cell changes

Other treatments for cell changes include:

  • Laser therapy or laser ablation. This uses a focused beam of light to burn away cell changes. You may notice a slight burning smell during treatment. This is the laser working and is nothing to worry about.
  • Cold coagulation (also called thermoablation). This uses heat to burn away cell changes using a thin tube (probe). 
  • Cryotherapy. This is more commonly used for cervical ectropion. It uses extreme cold to destroy cell changes using a thin tube (cyroprobe) with liquid nitrogen in it. The treatment may be repeated a couple of times to make sure it works as well as possible. 

Before any of these treatments, you will usually have a local anaesthetic. This means you are awake, but the area that needs treating is numb so you can’t feel it. The injection might sting for a short time.

These treatments are not used as often. You have them as an outpatient, which means you have them in hospital, but can go home afterwards. 

After treatment for cell changes

After treatment for cell changes, you may have some common side effects. We all react and heal differently after treatment, so you may not experience these effects exactly as we describe.

Your feelings after treatment 

Having treatment can affect your emotional wellbeing, as well as your body. After treatment, you may be worried about:

  • whether the treatment has worked
  • whether you will go on to develop cervical cancer.

All your concerns, including any we don’t mention here, are valid. Many people feel this way and it’s important you get the support you need. You can talk to your colposcopist about any worries you have, as well as to us. 

Get support >

Pain 

Some people have cramping pain, like a period, after treatment. The pain varies from person to person, but some pain is expected for a couple of days after treatment. 

If you are in a lot of pain or find it is affecting your day-to-day life, speak with your colposcopist or GP. They can offer reassurance based on your medical history and, if needed, will be able to check you are healing properly. 

Bleeding and changes to vaginal discharge

After treatment, a soft scab forms on the cervix where the cells were removed. While this heals, it may cause bleeding and changes to vaginal discharge. This can last about 4 weeks. 

Bleeding

Any bleeding is usually like a slightly heavy period. About 10 days after treatment, the bleeding may get heavier. This is very normal and simply the soft scab healing. 

If the bleeding is very heavy and you are soaking through a sanitary pad every few hours, it is important you go to the hospital straight away. It may not be anything to worry about, but they can check everything is okay and offer the right care.

Your first period (monthly bleeding) after treatment may be slightly heavier or out-of-sync with your regular cycle. 

Changes to vaginal discharge

Straight after treatment, you may have a watery vaginal discharge, and about 10 days after treatment, many women notice a coffee granule-like vaginal discharge. This is very normal and simply the soft scab healing. 

Speak with your GP if your vaginal discharge:

  • smells badly 
  • is a yellow or green colour. 

If you have an infection, your GP may give you antibiotics. 

If you have bleeding and changes to vaginal discharge

Until any bleeding has stopped and vaginal discharge has gone back to normal, your colposcopist may advise you not to:

  • have penetrative sex
  • use tampons 
  • swim. 

If you are unsure what you should or shouldn’t do, ask your colposcopist or GP.

Possible risks of treating cell changes 

Treatments for cell changes are considered safe. They are treatments that have been approved by health organisations in the UK and are usually successful. 

However, as with all treatments, there are some possible risks.

After LLETZ or cone biopsy, there is a small chance that the cervix will narrow. If this happens, the passage between the womb and vagina can become partly or fully blocked. This is called cervical stenosis. 

Cervical stenosis is more likely if:

  • you are going through or have been through menopause 
  • you have had more than 1 treatment
  • treatment removes a large area of the cervix 
  • treatment removes cells from inside the cervical canal (endocervix). 

If you are worried about cervical stenosis or think you may have it, speak with your colposcopist or GP. They can offer support and practical ways to help, like using a thin tube (dilator) with lubricant to help open the cervix. 

After LLETZ or cone biopsy, there is a slightly increased risk of miscarriage and giving birth before 37 weeks (prematurely). 

At first, this can sound alarming, but it’s important we try to understand exactly what is meant by this increased risk. In real numbers, after treatment about 2 in every 100 women will give birth prematurely. When we talk about premature births, in most cases we are talking about births between 32 and 37 weeks  – so not severely premature.

The level of risk will depend on:

  • how much of the cervix is removed
  • whether you have had more than 1 treatment.

However, the following is accepted:

  • If less than 10mm of cervical tissue is removed, your risk of premature birth is only slightly increased so you would not need any extra care from your pregnancy (obstetric) team.
  • If more than 10mm of cervical tissue is removed, or if you have more than 1 treatment, your risk is slightly more increased. 

Most LLETZ and cone biopsy treatments remove less than 10mm of cervical tissue. 

If you are planning on having children, it can be really worrying to read about these slight increased risks. It may help to remember that your healthcare team – both before and during any pregnancy – are there to support you and make sure you have the right care. You may want to speak with your colposcopist before treatment about any concerns, so they can answer your questions and give you support. 

Cervical stitch (cervical cerclage)

If you get pregnant in future, it is important to tell your midwife that you have had LLETZ. They may offer to do an ultrasound scan of your cervix. If they think it is short and there is a risk you may have the baby a bit early, they may offer you a cervical stitch (cervical cerclage). This is an operation where a stitch is placed around the cervix. It is usually done between 12 and 24 weeks of pregnancy, although it may be done later. 

If you are worried, it may help to speak with your colposcopist or midwife. They will be able to answer your questions and offer any support you need. 

The Royal College of Obstetricians & Gynaecologists have more information about cervical stitches >

Treating cell changes FAQs

Treatment is successful for about 9 in 10 people. It can be really upsetting if the treatment doesn’t work or if cell changes come back but, just like before, you will have an expert team caring for you. 

Even though cell changes like CIN and CGIN aren’t cervical cancer, you are sometimes offered treatment to reduce the risk of developing cervical cancer in the future.

Read about CIN and CGIN >

After LLETZ, it is important to listen to your body and take any time you need to rest. We all heal at different rates, so what feels right for someone else may not be right for you.

You can exercise as soon as you feel ready. Remember, any side effects usually last for about 4 weeks, so you may want to avoid heavy exercise during that time. If you do exercise, any bleeding may be a little heavier afterward.

If you have any worries or want to ask about a specific exercise, you can speak with your colposcopist before LLETZ. Or you can ask your GP, who knows your full medical history.

After LLETZ, side effects can last for about 4 weeks, so it is best not to have penetrative vaginal sex. This includes:

  • vaginal sex – for example, being penetrated by a penis, dildo or other object
  • fingering (having fingers inside your vagina)
  • oral sex (having a tongue inside your vagina).

The general rule is don’t put anything in your vagina while you have any side effects. If you want to have anal sex or clitoral stimulation, this shouldn’t make any side effects worse. 

If you are worried or have specific questions, it is best to speak to your colposcopist before treatment. Or you could speak to your GP, who knows your full medical history.

If you have a holiday planned soon after your treatment, speak with your colposcopist beforehand. They may recommend you don’t fly until any side effects have stopped – these may last for about 4 weeks.

Most treatments for cervical cell changes are still happening. In a few cases, the risk of becoming ill with, or passing on, coronavirus is greater than the risk of waiting a few more months for an appointment. If this is true for you, your doctor will let you know. You can call the colposcopy department and ask for more explanation, especially if getting answers will help with any anxiety or upset you may be feeling.

You will only be offered treatment if the colposcopy clinic and hospital are confident they can keep you and their staff safe. They will have put safety measures in place and you can support them by following any instructions they give you, for example about arrival times and wearing a face covering.

We have more information about what safety measures to expect in our colposcopy information. Read it now >

If you should not go to the hospital, for example if you are self-isolating or shielding, your colposcopy clinic will explain this and help you make arrangements once it is safe. 

How we can help

As well as leaning on your colposcopist, we are here for you. Our services are open if you want to talk through anything or simply have someone listen to your concerns on 0808 802 8000

Check our Helpline opening hours >

We also have a welcoming community in our online Forum, where you can get and give support. There are lots of conversations about cell changes, so you can choose to read existing threads or post your own messages. 

Join our Forum >

If you have general questions about cell changes or treatment, our Ask the Expert service may be able to help. Submit your question confidentially to our panel of experts and get a tailored reply. 

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 (2020). Cervical screening: programme and colposcopy management. www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management. Accessed May 2020.
  • The British Society for Colposcopy and Cervical Pathology (2019). For women – Frequently asked questions.
  • Lili, E., et al (2018). Low recurrence rate of high-grade cervical intraepithelial neoplasia after successful excision and routine colposcopy during follow-up. Medicine.
  • O'Connor, M., et al (2016). Adverse psychological outcomes following colposcopy and related procedures: a systematic review. BJOG: an International Journal of Obstetrics and Gynaecology.
  • Castanon, A., et al (2014). Risk of preterm delivery with increasing depth of excision for cervical intraepithelial neoplasia in England: nested case-control study. BMJ.
  • Sharp, L., et al (2009). After‐effects reported by women following colposcopy, cervical biopsies and LLETZ: results from the TOMBOLA trial. BJOG: an International Journal of Obstetrics and Gynaecology.
  • Suh-Burgmann, E. J., et al (2000). Risk factors for cervical stenosis after loop electrocautery excision procedure. Obstetrics & Gynecology.

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 >

Colposcopy >

Understand what happens at colposcopy and the different results you can get.

"It was decided it would be better and more comfortable for me to receive the LLETZ treatment under general anaesthetic"
Read Harriett's story
Date last updated: 
12 Jun 2020
Date due for review: 
23 May 2022
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