LLETZ at Parkside Hospital

What is LLETZ?

LLETZ is the short form of a longer official name: large loop excision of the transformation zone. A thin wire ring, carrying an electrical current, removes an area of abnormal cells from your cervix, the neck of your womb.

What conditions does LLETZ treat?

LLETZ deals with abnormal cervical cells that turn up during routine cervical screening, sometimes called a smear test. It's occasionally used to help confirm a diagnosis of cervical cancer too.

This treatment might be offered to you if:

• your smear result shows moderate or severe cell changes
• abnormal glandular cells turned up on your smear
• a biopsy has picked up CIN grade 2 or grade 3 changes
• the affected cells sit somewhere that can't be seen on the surface of your cervix.

CIN, short for cervical intraepithelial neoplasia, describes how far the affected cells reach into the cervix's lining. Grade 1 means up to a third of that lining's thickness is involved, grade 2 stretches to around two thirds, and grade 3 covers the entire thickness.

What are the benefits of having LLETZ?

Clearing away abnormal cells at this stage stops them going on to become cervical cancer further down the line. For the large majority of people treated, one round is all it takes.

Since it's carried out as an outpatient visit, staying overnight in hospital generally isn't part of the picture.

Are there different approaches to LLETZ?

Local anaesthetic is the standard choice, meaning you're conscious throughout while the area itself is numbed. General anaesthetic gets used from time to time instead, organised as a same-day admission, where that fits your situation better.

A near-identical treatment, known by the initials NETZ (its longer name is needle excision of the transformation zone), follows the same basic idea but swaps the loop-shaped wire for a straight one.

What happens before LLETZ?

• mention to the colposcopy clinic if you take anything that thins your blood, or have a condition affecting it
• there’s no need to change your eating or drinking habits beforehand
• being on your period when the appointment falls generally isn't a problem unless the bleeding is heavy; check with the clinic if you're not sure
• since the treatment can't go ahead if pregnancy's a possibility, keep up reliable contraception while you're waiting for your date
• with a coil fitted, you'll be asked whether you'd rather it stayed in place or came out; if it's coming out, condoms or avoiding sex for the week before helps prevent it leading to an unplanned pregnancy
• have your medication list ready, and mention any past medical issues or allergies to whoever's treating you
• take off any piercings below the waist before you set off
• it's worth having someone with you, just in case you feel a bit off afterwards.

What happens during LLETZ?

Plenty of people find this appointment awkward or upsetting, and that's a completely understandable reaction. Saying so is fine, and you're free to ask for a pause at any stage if things feel like too much.

1. Whoever's carrying out the procedure talks you through what's coming and checks you're happy to proceed.
2. You'll be asked to undress below the waist and lie back, legs supported and a sheet across you for cover.
3. An instrument called a speculum holds things open gently, letting your colposcopist get a clear view of your cervix through a magnifying scope known as a colposcope.
4. A local anaesthetic goes into the cervix itself; a brief sting, a quicker heartbeat, or wobbly-feeling legs for a couple of minutes are all typical and nothing to worry about.
5. Once you're properly numb, the wire loop lifts away the area of concern; there shouldn't be pain, though pressure and a faint burning smell often come with it.
6. The area gets sealed to control bleeding, and the speculum comes back out.

What does recovery look like?

You're free to head home right after the appointment ends. Should you feel lightheaded on standing, staff will get you lying back down and keep watching until you're steady enough to leave properly.

Arranging for someone else to drive is a good idea, though there's nothing stopping you getting behind the wheel yourself if needed. Go easy for what's left of the day.

Returning to work the following day is usually fine, provided your job doesn't call for heavy lifting or serious physical effort; where it does, a short break of a few days might suit better.

Expect some discharge or light bleeding afterwards, much like a period, running anywhere from a few days up to four weeks. Becoming a touch heavier around day 10 is common too, simply part of the healing process. A sanitary towel will be provided, though bringing your own is fine if you'd prefer.

Keeping infection at bay while things heal means avoiding, for a full four weeks: tampons or menstrual cups, penetrative sex, swimming pools and hot tubs, and anything strenuous enough to work up a sweat. Swap baths for showers during the first two weeks.

Before heading home, check how your results will reach you, whether that's a letter or a further clinic visit, since they usually come through within six weeks. A repeat smear test around six months afterwards then confirms the abnormal cells and HPV have gone.

What are the risks and complications?

Possible risks linked to LLETZ include:

• bleeding resembling a period, at times a little heavier, running anywhere from 2 days to 4 weeks
• discomfort along the lines of period cramps, also lasting somewhere between 2 days and 4 weeks
• infection, signalled by an unpleasant smell or a yellow or green tinge to discharge, which may call for antibiotics from your GP
• a small risk, somewhere around 2 in every 100, of a later pregnancy ending in birth before 37 weeks; this climbs if you've had LLETZ on more than one occasion, or if the area of cervix removed was over 10mm
• the cervix opening narrowing or scarring over, known as cervical stenosis, seen in somewhere between 2 and 14 people out of every hundred, which can leave periods irregular or painful and occasionally needs a straightforward procedure to widen things back out
• on occasion, a trace of the abnormal cells remaining, which is exactly why the later smear test matters.

Get in touch with your colposcopy team, ring 111, or head to A&E if a sanitary towel is soaking through within an hour, and see your GP if discomfort is severe or drags on beyond 3 months.

Your chances of becoming pregnant in future aren't affected by having had LLETZ.