LLETZ
Patient Information
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Leaflet Number:
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AB
Gyn 007
8
LLETZ
September 2016
September 2018
What is LLETZ?
LLETZ stands for Large Loop Excision of the Transformation Zone. It is performed to
remove abnormal changes that have occurred on your cervix (neck of the womb). This is a
simple safe technique with excellent results and is the most commonly used method of
treatment in UK.
It is also called ‘loop treatment’ or ‘Diathermy Excision’ or ‘Loop Electrical Excision
Procedure’ (LEEP).
Why do I need treatment?
Following your recent cervical screening test (smear) or colposcopy and cervical biopsy
you have been advised that you need treatment to the cervix because of pre-cancer
changes, also known as Cervical Intraepithelial Neoplasia (CIN). This is not cancer but has
the potential to progress into cancer if left untreated. LLETZ treatment has the aim of
removing the CIN and therefore preventing cancer developing.
CIN is caused by a virus called Human Papilloma Virus (HPV), also known as wart virus.
This can affect anyone, is very common and usually clears up on its own. If HPV persists,
it may lead to CIN.
Precancerous changes (CIN) are divided in to mild (CIN1) and Severe (CIN 2, CIN 3,
CGIN) changes.
Not all CIN cells need treatment, it is usually only those that are CIN 2 and above or
occasionally CIN 1 which has failed to disappear despite close monitoring for some time
usually for 2 years or more.
How is it performed?
It involves using a local (numbing) anaesthetic. You will not be put to sleep. The doctor
removes the abnormal tissue using a fine heated wire loop. A small diathermy pad will be
applied to your thigh. This is used as a safety procedure for the LLETZ equipment and is
removed when the procedure has been completed.
You will be placed in the same position as for a smear test and/or a colposcopy, on a
specially designed couch, which makes the procedure more comfortable.
Is it painful?
The cervix is relatively insensitive to pain. Prior to treatment the cervix is numbed with an
injection of local anaesthetic using a small needle; however some discomfort, like a period
pain, or a warm sensation is sometimes felt during this procedure.
Will it cure me?
Over 90% are cured by the first treatment. Women who have had treatment are at much
lower risk of developing precancerous changes again but remain at slightly higher risk for
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recurrence compared to those women who never needed treatment in the first place.
Therefore it is very important to attend for the follow up smears.
A few patients will require a second treatment and even less will require an alternative
treatment such as cone biopsy or hysterectomy.
How long will it take?
On average, about 15 to 20 minutes. The treatment itself is very quick and takes only few
seconds. Examination (using the colposcope) and preparation for the procedure will take
longer (5 to 10 minutes.) You should plan to spend about an hour in the clinic to allow a
period of 30 minutes rest afterwards.
It may be a good idea you bring a friend or a family member with you where possible to
accompany you home.
What are the Benefits?


It successfully removes the abnormal cells in over 90% of the time.
This allows us to send removed part to the lab to be checked and confirm that the
abnormal area is completely removed.
What can I expect afterwards?
You may experience some or none of the following.

You may notice some period-like cramps as the anaesthetic wears off. If this is the
case, you can try taking 2 x 500mg paracetamol or 2 x 200mg Ibuprofen (if you
have no allergies or previous problems with Aspirin) tablets to relieve the pain.
You may prefer to take them an hour before your clinic visit.

You will have a bloodstained vaginal discharge for some time. This usually settles in
2 weeks but may last for up to 4-6 weeks. The discharge should not be heavier and
should get progressively lighter. You may also see black particles, which is normal
and is caused by the diathermy (cautery) used during the treatment.

Initially the bleeding is often fresh red like a period before changing to a pink, then
brown discharge. If you are worried that this is not the case, we advise you contact
us using the phone numbers provided at the end of this leaflet or see your GP.

Your next period may arrive earlier and may be heavier than normal.
Everyone is different and heals differently and some women will experience
discharge for longer than others. The cervix needs time to heal.
What are the Risks?
Bleeding:
It is normal to have some light bleeding and discharge for up to four to six weeks following
the treatment to your cervix. We would not expect you to have heavy bleeding.
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In the unlikely event that you have heavy bleeding, which is heavier than your normal
period or if you are passing blood clots we would advise you to contact us or attend the
A&E department.
Infection:
There is a small chance of developing infection (1in10) following treatment, which usually
presents as a smelly vaginal discharge. Less commonly you may also experience fever or
ongoing pain in your lower tummy. If you experience any of these symptoms we advise
you to contact us or see your GP without delay so that you can be checked for infection
and be given a prescription for antibiotics as appropriate.
Premature delivery:
This treatment should not affect your ability to become pregnant. However, treatment may
weaken the cervix and may slightly increase the risk of premature delivery (before 37
completed weeks). This risk is more significant for women who had repeat treatment or
cone biopsy than those who had a single treatment.
Therefore, if you get pregnant following this treatment we advise you to inform your GP
and midwife that you have had treatment to your cervix.
Narrowing of the cervix:
Following treatment to your cervix there is a small risk that the cervix (opening of the neck
of the womb) may become narrower. Again this is more common with repeat LLETZ or
Cone biopsy. Some times this may cause difficulty in obtaining satisfactory smears in the
future.
It is important to remember that the benefits of LLETZ are greater than its risks.
Alternative treatments:



Diathermy or Cryocautery - destroying abnormal area of the neck of the womb by
heating or freezing it. The disadvantage of these procedures is that there will not be a
tissue sample for analysing in the lab as the cells are destroyed during the treatment.
Cone Biopsy - removing larger portion of the neck of the womb in shape of a cone
(normally done under general anaesthetic in operating theatre). This is only advised in
certain situations, which will be discussed with you if indicated.
Hysterectomy – removing the womb and the neck of the womb under general
anaesthetic (in operating theatre). This is considered as a last resort usually in some
difficult situations or for women who also have other Gynaecological problems justifying
a major operation.
Advice following treatment:
Take it easy for the next two or three days. You will experience some vaginal bleeding
and discharge, and this may last up to four to six weeks on and off.
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If you have bleeding, which is heavier than a period, or an offensive discharge, contact
Hanover Women’s Healthcare Unit or your GP. If you have any problems out of hours,
contact Swinley Ward for advice.
Do not have intercourse and do not use tampons for 4 weeks. Your next period may be
slightly heavier than normal. It may come earlier.
Avoid baths, swimming and strenuous exercise for 2 to 4 weeks. Showers can be taken as
normal.
Follow-up
Once we have the results we will write to you informing you of the result. It may take four
to six weeks before you hear from us. We will also send you an appointment to attend the
clinic or ask you to see your GP for a further smear in 6 months’ time. This is to check if
the treatment has been effective.
This is called Test of Cure (TOC). This means the smear is checked for both abnormal
cells and the HPV virus. Ideally we expect that this smear test shows no abnormal cells
and that there is no evidence of HPV virus. In this case you will be discharged back to 3
yearly smears. Sometimes the smear may show minor residual abnormal changes.
Provided there is no HPV virus you will still be discharged back to 3 yearly smears.
On the other hand if your smear is either normal or mildly abnormal but positive for HPV
then you will be sent an appointment to the colposcopy clinic for a further check of the
cervix.
It is important to recognise that the LLETZ treatment is primarily aimed at removing
abnormal cells, but not intended to treat wart virus infection.
Pregnancy and contraception
It is advised that you avoid pregnancy until you have had your first follow-up smear and
have had a normal result.
You should continue to use your normal contraception. If you were not using
contraception, we would advise a sheath (condom) until after you have been treated. If
you have a coil, we may or may not have to remove it. We advise you to use additional
contraception or abstain from intercourse for the 7 days before your treatment in case if
the coil needs to be removed for the purpose of treatment. This is in order to reduce the
risk of contraception failure and pregnancy, also to avoid any delay in the treatment. If we
do have to remove it we will arrange to have it re-inserted either the same day, or in 4 to 6
weeks’ time.
Contact Numbers
If you are on period, or cannot attend for some other reason please ring:
Hanover Women’s Healthcare Unit, Telephone 01942 264959 / 60; Monday to Friday,
9:00 am to 4:30 pm
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If you have any queries or worries of any kind contact Hanover Women’s Healthcare Unit
and ask to speak to a nurse.
Out of hour’s emergencies only:
Contact Swinley Ward, Royal Albert Edward Infirmary, Wigan, 01942 822568.
Colposcopy Secretary: Telephone: 01942 264091 Monday to Friday 9:00 am to 4:30
pm.
Further information
Websites - We believe that the websites below have more detailed and reliable
information, which can help answer more of your questions.
www.bsccp.org.uk
www.jotrust.co.uk
www.gov.uk
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Comments, Compliments or Complaints
The Patient Relations/Patient Advice and Liaison Service (PALS) Department provides
confidential on the spot advice, information and support to patients, relatives, friends and
carers.
Contact Us
Tel: 01942 822376 (Monday to Friday 9am to 4pm)
The Patient Relations/PALS Manager
Wrightington, Wigan and Leigh NHS Foundation Trust
Royal Albert Edward Infirmary
Wigan Lane
Wigan WN1 2NN
Ask 3 Questions
Become more involved in decisions about your healthcare. You may
be asked to make choices about your treatment. To begin with, try to
make sure you get the answers to three key questions:
1. What are my options?
2. What are the pros and cons of each option for me?
3. How do I get support to help me make a decision that is right
for me?
This leaflet is also available in audio, large print, Braille and other languages upon request.
For more information call 01942 773106.
© Wrightington, Wigan and Leigh NHS Foundation Trust
All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
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