What is large loop excision of the transformation zone (LLETZ)?
You will be offered this if you have:
- A moderate or severely abnormal (dyskaryotic) smear
- Abnormal glandular cells on your smear
- A biopsy that shows CIN 2 or 3
- A biopsy that shows abnormal glandular cells
- Your abnormal cells are not visible on the outside of your cervix
- If the birth canal is not fully visible, therefore allowing us to take a tissue sample of an area we cannot fully see by colposcopy.
This can be offered at the first visit. The procedure will be explained, and you will be asked to sign a consent form. A colposcopy examination will then be carried out as described on the leaflet ‘Colposcopy examination’. Occasionally it may be more appropriate to have the procedure under a general anaesthetic but if this is the case, your clinician will explain everything and arrangements for a future day case admission will be made.
We advise all patients with coils who are due for loop excision to avoid sexual intercourse or use barrier contraception (e.g. condoms) for 7 days prior to treatment just in case the coil needs to be removed (FFPRHC 2006) Please see section later.
What is it and what will happen?
The LLETZ procedure, which is also known as loop excision, 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 in clinic under a fast acting local anaesthetic, where just the area being treated is numbed, but you will still be awake. Whilst it is taking effect the team will set up the rest of the equipment: a sticky pad is attached to your thigh to ensure a safe return path for the electric current being and a plastic tube attached to the top of the speculum to circulate cool air. Sometimes the anaesthetic can sometimes make you feel a little strange: it can make you heart beat faster and your legs feel wobbly. If this happens please do not panic, it is quite normal and will settle quite quickly. Breathe normally and don’t worry about shaky legs. The nurses in clinic are there to support you and the symptoms quickly go away.
Once we are sure that the anaesthetic has numbed the area, the treatment can get under way. The treatment itself usually only lasts a few minutes and shouldn’t be sore but sometimes you may feel a bit of pressure.
The advantage of this treatment is that the cells are removed rather than destroyed, so that the tissue can be sent for further tests to confirm the extent of the cell changes and make sure the affected area has been removed. Although this may sound scary patients typically only feel a slight discomfort during the procedure. It is very safe and the whole procedure usually only takes around 15 minutes.
What if I have a coil? (Intra-uterine contraceptive device, IUS, IUCD)
You will be offered the choice of having the coil removed or leaving it in. Both options can have associated problems. If the coil is left we will tuck the threads inside the cervix, however sometimes the strings may get cut by the loop. This will not have any immediate effects but may cause difficulty when the coil needs to be removed.
Taking the coil out can only be done if there is no chance of you getting pregnant. Hence you will be asked whether you have had sex in the last 7 days. If there is any doubt or concern, the treatment will be delayed until the coil can be safely removed.
If the coil is removed, it can be replaced 6 weeks later in your general practice. We advise all patients with coils who are due for loop excision to avoid sexual intercourse or use barrier contraception (e.g. condoms) for 7 days prior to treatment just in case the coil needs to be removed (FFPRHC 2006)
Will it be sore?
During the procedure you should not experience any pain, some women feel what they describe as pressure or a bit of heat and some describe some period like pains.
Post treatment advice following
What to expect
You are likely to have some bleeding because of the soft scab that forms on the cervix where the cells were removed. This may bleed while it heals. The bleeding is usually like a period, but may be slightly heavier than your normal period. About 10 days after treatment, the bleeding may get heavier. This is common and a sign that the scab is healing. Your first period after treatment may be slightly heavier or out-of-sync with your regular cycle.
Important! If you are on blood thinning medication or you have a haematological condition, you must tell your colposcopist because you may have a higher risk of bleeding after LLETZ.
Some pain is expected for between 2 days to up to 4 weeks after treatment. The pain varies from person to person, but should not be too severe. It is often described as a cramping pain, like a period. You can talk to your doctor about over-the-counter medication that should help.
Important! Some people may experience pain for longer. If you are in a lot of pain or find it is affecting your day-to-day life, talk to your GP. They can advise on pain medication, offer reassurance based on your medical history and, if needed, will be able to check you are healing properly.
There is a small risk of infection after LLETZ. Talk to your GP if your vaginal discharge smells bad, or is a yellow or green colour. If there is a chance you have an infection, you will be offered antibiotics.
- Some patients notice a difference in the timing and length of their periods afterwards.
- There is a small chance that as the cervix heals it scars up making the canal narrow and makes it difficult for the blood to escape when you have a period. This is called stenosis.
- Research suggests that with a loop of less than 15mm deep there is no associated increase in the chance of pre-term labour or pre-term rupture of the membranes.
- There may be a small increase in miscarriage before 20 weeks, but this is small and controversial.
- Deeper and repeat treatments could increase your chance of premature delivery.
- There is no evidence that LLETZ will affect your ability to get pregnant.
- We aim the treatment to remove all the abnormal cells but occasionally some get left behind (residual abnormality). This is why it is important to attend for your follow up smear which will recognise if any abnormal cells and HPV virus are still present.
- Damage to other tissues is very rare.
Please note that some travel insurance policies will not cover you for complications if you go on holiday within 4 weeks of having a LLETZ. You may wish therefore to defer until you return from holiday.
To reduce the risk of bleeding and infection you MUST AVOID:
- Tampons for any bleeding, use pads for four weeks.
- Vaginal intercourse for four weeks
- Insertion of vaginal pessaries or oestrogen for two weeks
- Swimming for two weeks, or until any discharge has stopped
- Soaking in a bath or hot tub, shower for the first two weeks and do not douche
- Undertake excessive strenuous exercise for two weeks
If you have any questions or problems following treatment, please contact the clinic - Direct Line 01228 814263 to speak to one of our members of staff.
West Cumberland Hospital Colposcopy secretary 01946 523219
Cumberland Infirmary Colposcopy secretary 01228 814220
Can I bring someone with me?
You are welcome to bring someone with you if you wish.
Can I drive home?
Yes you can drive home after the procedure.
Can I drink alcohol post procedure?
Yes, you can drink alcohol after the procedure.
Results/follow-up
You and your GP will receive the results of your treatment sample and plan for your follow-up via letter in 4weeks. You will require a cervical screening test (smear), 6 months after treatment, this is usually with your GP practice, this notification or changes to this will be included in your letter. If you have not received your results after four weeks please contact one of the colposcopy secretaries, Carlisle 01228 814213 or West Cumberland 01946 523219.
Smoking
You should be aware that smoking can make cervical changes occur more rapidly and more likely to persist or come back following treatment. Advice on stopping smoking is available from your GP, practice nurse.
Periods
Some patients report a change in menstrual pattern which is usually temporary. If you are concerned, see your GP who can refer you if necessary.
Useful contacts
Gynaecology Specialist Nurse Cumberland Infirmary Telephone 01228 814217
Gynaecology Specialist Nurse West Cumberland Hospital - Telephone 01946 523217
Colposcopy Specialist Nurse - Telephone 01228 814220 or 814213
Consent
Name of procedure Loop excision of transformation zone (loop biopsy of cervix)
Intended benefits of procedure. To diagnose abnormality and/ or remove cervical cell changes.
Risks of LLETZ
Risks of doing nothing
- Alternative treatments
I have read the information provided and agree to LLETZ procedure
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For further information on confidentiality contact the Information Governance Team:
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Feedback
We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:
pals@ncic.nhs.uk | 01228 814008 or 01946 523818
If you would like to raise a complaint regarding your care, please contact the Complaints Department:
complaints@ncic.nhs.uk | 01228 936302