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This information is aimed at primary and second care staff, including sample takers, general practitioners, colposcopists, colposcopy nurse specialists and colposcopy nurse. It may also be useful for other healthcare professionals.
Your patients may be very anxious when they find out they have some cervical cell changes (abnormal cells). They may have lots of questions about what it means for them, and about their suggested treatment. Remember – you don’t have to know all the answers. We can offer advice and support through our Helpline on 0808 802 8000. But here is more information about some common questions you and your patients may have.
There are no symptoms. Cervical cell changes are picked up through screening and colposcopy, which is why it’s so important patients have accurate information about screening.
Cervical cell changes are not cancerous. But they may go on to develop into cancer if they’re left untreated. Treatment removes the cell changes a long time before this happens.
Women and people with a cervix who are told they have abnormal cells may be very worried if their colposcopist suggests no treatment. But very often, cells go back to normal, especially if the changes are only mild (CIN1). The immune system deals with them on its own. Even the higher grade CIN2 changes go back to being healthy within two years in around half of cases, research shows. This is known as ‘regression’. Treatment does have some risks and side effects so it’s important to avoid carrying it out unnecessarily.
You can reassure patients they won’t be left on their own, but explain it is important they go for their follow-up appointments. They’ll be monitored closely so their healthcare team will quickly know if the abnormal cells aren’t going away. They can then be treated if necessary.
CIN2 changes are considered high grade, though not as serious as CIN3. In over half of cases, CIN2 changes go back to normal within two years, while about 1 in 5 progress to CIN3. This means that conservative management is often recommended, which means a patient would be invited for regular appointments to check the cell changes are clearing.
However, a decision about treatment should be made taking the patient’s individual situation and wishes into account. It’s important they understand the benefits and risks of treatment and can make an informed decision with their healthcare team.
It is rare for this to happen. Treatment is successful in most cases.
If cell changes do come back, a patient can be treated again in the same way to remove the cells. You can reassure your patients they will be monitored after treatment. Even when they’re discharged back to routine cervical screening, tests look for high-risk HPV, the virus that can go on to cause cervical abnormalities. So the healthcare team will be able to tell a long time in advance if there’s any risk of abnormal cells coming back.
In rare cases, if abnormal cells keep returning, doctors may talk to a patient about having a hysterectomy, which removes the womb and cervix and prevents any future problems. But this is very unusual. All treatment should take the patient’s wishes into account.
Bleeding after LLETZ is expected. After treatment, a soft scab forms over the area and can cause bleeding while it heals, usually for about four weeks. The bleeding may be slightly heavier than a normal period. Often, after around 10 days, bleeding may get heavier for a short time. This is a good sign as it means the scab is healing as it should. The first period after LLETZ may be a bit heavier than usual, and may come at a different time. All this is normal. But if bleeding becomes very heavy, to the extent it soaks through a pad in a few hours, someone should always speak to their healthcare team. It’s probably nothing to worry about but it’s best to be checked out.
The scab on the cervix can cause discharge to change temporarily. Immediately after treatment, there’s often watery discharge. And then, after about 10 days, discharge may start to resemble coffee granules. This is all normal. But it’s important patient knows they should seek advice if discharge turns yellow or green, or becomes smelly. These may be signs of an infection and they might need antibiotics.
There can be side effects, such as bleeding, for a few weeks after treatment. For this reason, it’s best to avoid penetrative sex of all kinds. That means any sex in which something is put into the vagina. A patient can still enjoy masturbation and intimate contact with a partner that doesn’t involve penetration.
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.
We write our information based on literature searches and expert review. For more information about the references we used, please contact [email protected]