LEEP/LLETZ

What is LEEP/LLETZ?

LEEP is a procedure for removing a type of abnormal tissue growth in the cervix called cervical intraepithelial neoplasia (CIN). It uses a thin wire loop attached to an electrical unit.

The cervix is the lower portion of the uterus that opens into the vagina. The uterus is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus, through the cervix.

LEEP is an abbreviation for loop electrosurgical excision procedure. It is also referred to as large loop excision of the transformation zone, or LLETZ.

When is it used?

Abnormal cells or tissue is most often discovered from a Pap test. The Pap test is a screening test done during a woman's pelvic exam. Several types of CIN can become cancer if not found and treated. Removal of the abnormal cells can help prevent cancer of the cervix.

How do I prepare for LEEP?

You should avoid sex or douching for 48 hours before the procedure.

What happens during the procedure?

This procedure is best done when just after your menstrual period.

You lie on a treatment table and put your feet in stirrups, just as you would for a pelvic exam. Your healthcare provider then looks at your vagina and cervix through a colposcope, which is like a magnifying glass. Your healthcare provider puts a solution on the cervix to highlight the problem areas on the cervix. Once your provider sees the area where the CIN is, he or she numbs the cervix with a local anesthetic. Your provider then removes the abnormal tissue with the electrical cautery wire loop. The loop is used to scoop out the abnormal tissue in one piece and to seal any bleeding blood vessels. A medicated paste may then put on the cervix to further reduce the risk of bleeding. All you may feel is a slight tingling. The procedure usually takes less than 5 minutes.

The removed tissue is sent to a lab for testing.

What happens after the procedure?

You can return to normal work activity or school the same day. You may have a little cramping after the procedure. You may also have some minor bleeding or spotting the first day or so after the procedure. For about 2 weeks you may have a brownish discharge. This is a normal part of the healing of your cervix. Your cervix should heal completely within a month.

You should avoid heavy lifting, tampons, douching, sexual intercourse, and hot tubs for 1 month after the procedure.

See your healthcare provider for follow-up visits and Pap tests as recommended.

What are the benefits of this procedure?

LEEP allows your healthcare provider to locate and remove precancerous cells. It can be done in your provider's office and does not require a general anesthetic. (If the tissue were removed surgically by a cone biopsy, you might need to have general anesthesia.)

What are the risks of this procedure?

• You may have heavy bleeding.
• Rarely the cervix may become infected. Infection may cause the opening in your cervix to become narrower. The narrowing might make it more difficult for you to get pregnant.
• Sometimes the healing of the area from which the tissue was removed may cause the cervical opening to become narrower or scarred. The narrowing might make it more difficult for you to get pregnant.
• The tissue of the cervix may be weakened. This is called an incompetent cervix and it could lead to a premature birth of a baby if you become pregnant.

When should I call my healthcare provider?

Call your healthcare provider right away if:

• You have a fever over 100.5°F (38°C).
• You have severe abdominal pain.
• You have any discharge from your vagina that has a bad odor.
• You have bleeding that lasts more than 1 week.
• You have heavy bleeding and need to change your pad 2 to 3 times per hour (with or without clots).

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.