Cervical abnormalities: CIN3 and CGIN

LLETZ (loop diathermy)

The most common treatment for CIN2 and CIN3 these days is loop diathermy also know as LLETZ – Large Loop Excision of the Transformation Zone (LEEP outside the UK – Loop Electro-Excision Procedure). Its aim is to remove all the abnormal cells from the cervix. A wire loop with an electric current (diathermy) is used to remove these cells. This leaves a raw area on the cervix, which heals very well. The healed cervix should then contain only healthy tissue, without any abnormal cells.

LLETZ is usually performed in a hospital as an outpatient. The procedure takes about five minutes and is carried out under local anaesthetic. Like colposcopy, LLETZ is not usually performed if a woman has her period.

Some of the women we interviewed had a colposcopy and LLETZ in the same appointment and were pleased to be treated there and then.

Some of the women we talked to had LLETZ shortly after their colposcopy, while others had to wait several weeks. Many found that difficult and a few felt very anxious and isolated. On the day of treatment, some went to the hospital alone while others said they took their partner, mum or a friend with them for support. Some said it was helpful to have another person there to listen to the information they were given.

Many of the women interviewed recalled signing a consent form and having the procedure explained. Some, though, said they would have liked more information beforehand. Most found the treatment painless, though a few felt a little stinging sensation when they were given the local anaesthetic. Two women said they took a paracetamol before going to the hospital and felt no pain at all. Several said that having the treatment was better than they’d expected.

Some of the women we spoke with said they were interested in watching the procedure on the screen, while others felt that talking to the nurse helped to take their mind off it. A few women recommended wearing a skirt. Anna, who’d had her colposcopy while travelling abroad and a LLETZ in England, was happy with the treatment she’d been given and wrote to thank the medical staff afterwards.

Some of the women we talked to said they felt worried and anxious on the day of treatment but the LLETZ procedure was explained to them and the staff were very caring and reassuring. They held their hand during the procedure and chatted to them throughout.

A few women found having the local anaesthetic difficult.

Several women said they were treated by LLETZ under general anaesthetic instead of a local. One of these women said she felt happier having a general anaesthetic, though the other was very anxious and eventually another doctor at a different hospital treated her using local anaesthetic.

A few women were particularly anxious on the day of treatment because doctors had told them that they might have cervical cancer as well as CIN3 / CGIN.

Claire had an uncommon experience – she had abnormal cervical screening tests (smears) but normal colposcopies. At the time of interview, she was considering having a LLETZ but was concerned about being over-treated and the impact of treatment on future pregnancies (see ‘Fertility and pregnancy).

After treatment, most of the women we talked to were told about aftercare and follow-up care (see ‘Healing after LLETZ or cone biopsy’ and ‘Follow-up care’).

Two women were treated a second time by LLETZ, both at their first follow-up appointment, because there were no ‘clear margins’, i.e. the area of abnormality had not been completely removed.

One woman said she wasn’t at all worried about having treatment – her only concern was recurrence.

In 85–95% of women, their cervical abnormalities (CIN or CGIN) are successfully cleared after one treatment, but between 5 and 15% of women will still be affected by CIN or CGIN after treatment*.

A few women did have a recurrence several years after their first treatment and were treated again, usually by LLETZ (see ‘Recurrence of abnormal cells’). More experiences of LLETZ can be found on our cervical screening section.

*Onuki M et al, 2016. Post treatment human papillomavirus testing for residual or recurrent high-grade cervical intraepithelial neoplasia: a pooled analysis. The Journal of Gynaecological Oncology 27(1), e3. www.ncbi.nlm.nih.gov/pmc/articles/PMC4695453/. Accessed: 11.01.2017. 

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Last reviewed July 2017.
Last updated July 2017.


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