Having a LLETZ (Large Loop Excision of Transformation Zone) Treatment – Loop Excision

This leaflet tells you that a Loop excision is the most common treatment for abnormal cervical cells. A thin wire loop heated by an electric current removes the affected area of the cervix. The removed tissue is sent to a laboratory for microscopic examination.

You may be offered this treatment if you have:

• A moderate or severe abnormal cervical screening result (smear).
• A smear result showing abnormal glandular cells.
• A biopsy showing abnormal glandular cells.
• A biopsy showing high grade changes CIN.

This treatment may be offered at your first visit. The procedure will be explained and a colposcopy examination will then be performed.

What is CIN?

There are 3 grades of CIN and they relate to how deeply the abnormal cells have gone into the skin covering the cervix:

• CIN 1 (low grade) – up to one third of the thickness of the lining covering the cervix has abnormal cells.
• CIN 2 (high grade) – up to two thirds of the thickness of the lining covering the cervix has abnormal cells.
• CIN 3 (high grade) – the full thickness of the lining covering the cervix has abnormal cells.

What will happen when I attend the clinic?

At the colposcopy clinic, a trained colposcopist (doctor or nurse) will examine your cervix to identify any abnormal cells that may be visible.

A fast-acting local anaesthetic is injected into the cervix. While it takes effect, the equipment is prepared. A sticky pad is placed on your thigh to safely return the electric current from equipment to be used, and a suction tube attached to the speculum which helps to circulate cool air.

Once the anaesthetic is working, a thin electrical wire loop (hence the name) is used to remove the abnormal area. The area is then sealed with a different electrical instrument to prevent bleeding. This is a safe procedure and usually takes about 15 minutes.

Advice before having a LLETZ

If you have a period when your appointment is due, treatment can usually go ahead unless your bleeding is heavy. If you are unsure, please contact the colposcopy office for advice.

If you take blood-thinning medication, please contact the colposcopy office when you receive your appointment letter. The administrative team will inform the colposcopist, who will contact you with the appropriate advice.

We cannot carry out treatment if there is any possibility that you are pregnant. Please use reliable contraception while waiting for your appointment, even if you do not usually use it.

If you discover you are pregnant before your appointment, please still attend for assessment by the doctor or nurse colposcopist. After assessment, a follow-up plan will be arranged and treatment can usually be delayed until the end of your pregnancy or until 3 months after delivery.

What if I have a coil? (Intra-uterine contraceptive device, IUS, IUCD)

You can choose to have your coil removed or left in place before treatment.

Both options have potential disadvantages.If the coil is left in place, the strings may be cut during treatment. This will not cause any immediate problems but may make the coil more difficult to remove in the future.

If you have a coil, use additional contraception (such as condoms), or avoid sexual intercourse, for 7 days before your appointment. This is because the colposcopist may need to remove the coil before treatment.

Removing a coil within 7 days of unprotected sex can result in pregnancy. You will be asked whether you have had sex in the previous 7 days when you attend for treatment.

If there are any concerns about safely removing the coil, your treatment may be postponed. If your coil is removed, it can usually be replaced after 6 weeks by your GP or local sexual health/contraception clinic.

Is the treatment painful?

The treatment is usually painless or causes only mild discomfort because a local anaesthetic is used. Some women may experience period-like pain for a day or two afterwards, which can usually be relieved with over-the-counter painkillers such as paracetamol or ibuprofen.

Does the treatment have any side effects?

LLETZ is generally a safe procedure, but complications can occur:

• Up to 50% of patients experience some bleeding and vaginal discharge for up to 10 days, this may be light to moderate loss.
• Mild to moderate pain is common for the first 1 to 2 days.
• Infection may cause a smelly discharge or sometimes increased bleeding. If this occurs contact your GP for antibiotics as they may be required.
• In rare cases bleeding can be very heavy, enough to require assessment in hospital.
• Occasional change in timing and duration of menstrual cycle.
• There is a small risk of cervical stenosis (narrowing of the cervical canal) during healing.
• Although treatment aims to remove the abnormal cells, on occasion some may remain. It is therefore important to attend follow-up with regular cervical screening when invited to check for HPV and abnormal cells.
• LLETZ does not affect fertility or your ability to become pregnant.
• Research also shows that an on-off procedure of LLETZ excision of less that 10mm deep does not increase the risk of preterm labour.

To keep the risk of infection as low as possible you MUST AVOID:

• Sexual intercourse for 4 weeks.
• Using tampons for 4 weeks.
• Swimming or use of hot tubs for 4 weeks.
• Taking long soaks in the bath for the first 2 weeks (shower instead).
• Strenuous or excessive exercise for 2 weeks.

Can I bring someone with me?

Yes. You are welcome to bring someone with you to your appointment. Although it is safe to drive afterwards, many patients prefer to have someone accompany them home. We recommend taking it easy for the rest of the day following the procedure.

What about work?

Most patients can return to work the following day. However, if your job involves heavy lifting or strenuous activity, you may need to take a few days off to recover.

Important: Some travel insurance providers may not offer medical cover following this procedure. If you are planning a holiday or flying within 4 weeks of treatment, you may wish to consider arranging your colposcopy treatment for an alternative date.

What happens next?

The tissue removed from your cervix will be sent to the laboratory for analysis. You will usually receive your results by letter within 4 weeks. 

You will also be asked to have a follow-up cervical screening test (smear) 6 months after treatment to check that no abnormal cells or HPV remain. This can usually be carried out either at the hospital clinic or at your GP surgery.

For approximately 95% of patients, no further treatment is needed. However, a small number of patients may require a second treatment if the abnormal cells return.

Very rarely, cervical cancer can still develop after treatment (around 3 in 10,000 patients), which is why attending your follow-up cervical screening appointments is so important.

In exceptional circumstances, a hysterectomy may be recommended. If this becomes necessary, your treatment options will be discussed with you in detail.

Contact numbers:

University Hospital of North Tees

Outpatients Department:
Monday to Friday, 09.00am to 5.00pm
Telephone: 01642 624172

University Hospital of Hartlepool

Outpatients Department:
Monday to Friday, 09.00am to 5.00pm
Telephone: 01429 522865

You can also contact a Specialist Nurse Colposcopist on the following number:
Colposcopy Hub
Monday to Friday, 8.30am to 4.30pm
Telephone 01429 522268

Email for enquiries: [email protected]

If you have any worries or concerns, you should contact your GP during normal surgery hours. Outside surgery hours, you should contact your GP’s surgery for the Out of Hours Service number.

Further information is available from:

NHS website – www.nhs.uk

www.cancerresearchuk.org
www.cancerscreening.nhs.uk

The British Society for Colposcopy and Cervical Pathology: www.bsccp.org.uk

References

Public Health England (2025) NHS Cervical Screening Programme, Colposcopy and Programme Management. NHSCSP Publication 20. 3rd Edition.

Luesley D (Ed), Shafi M (Ed), Jordan J (Ed). Handbook of Colposcopy (1996). Publishers Chapman and Hall

Patient Experience Team (PET)

North Tees and Hartlepool NHS Foundation Trust would like your feedback. If you would like to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Team who will help you to do this.

This service is based at the University Hospital of North Tees but also covers The University Hospital of Hartlepool, our community hospitals and community health services.

North Tees and Hartlepool NHS Foundation Trust
Telephone: 01642 624719
Freephone: 0800 092 0084
Email: [email protected]
Monday to Friday, 9:30 am to 4:00 pm

Out of Hours
If you wish to speak to a senior member of Trust staff, please contact the hospital switchboard (numbers below).