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 (known as 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 is on 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.

The doctor could see the area that needed treatment and Anna was pleased to be treated sooner…

Age at interview 34

Gender Female

Age at diagnosis 33

View profile

Jo felt shocked and unprepared to be treated at colposcopy but her mum persuaded her to go ahead…

Age at interview 33

Gender Female

Age at diagnosis 25

View profile

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.

A doctor explains why some women are treated at the colposcopy appointment while others might be…

Gender Female

View profile

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.

Anna was nervous beforehand but the procedure was similar to a smear. Apart from a bit of…

Age at interview 29

Gender Female

Age at diagnosis 28

View profile

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.

The atmosphere was very relaxed. The procedure was painless and had little impact on Annas life…

Age at interview 28

Gender Female

Age at diagnosis 27

View profile

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.

Lizzie was extremely anxious before surgery and was prescribed a sedative. The staff were very…

Age at interview 39

Gender Female

Age at diagnosis 36

View profile

A few women found having the local anaesthetic difficult.

The local anaesthetic was a bit uncomfortable. Sandras blood pressure dropped after the…

Age at interview 50

Gender Female

Age at diagnosis 48

View profile

Pam would have liked to have had LLETZ under a general anaesthetic because she found it very…

Age at interview 40

Gender Female

Age at diagnosis 38

View profile

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.

Genevieve was given a light general anaesthetic and describes what happened when she went into…

Age at interview 41

Gender Female

Age at diagnosis 33

View profile

Bev changed to another doctor because she felt strongly about being treated under local…

Age at interview 33

Gender Male

Age at diagnosis 33

View profile

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.

Patricia was shocked and scared that she might have cancer. She felt faint after surgery and…

Age at interview 55

Gender Female

Age at diagnosis 38

View profile

The doctor suspected Rachel might have cancer, but was pleased to confirm after treatment that it…

Age at interview 36

Gender Female

Age at diagnosis 35

View profile

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 potential future pregnancies (see ‘Fertility and pregnancy).

Claire, a doctor, was being monitored but hadnt had treatment yet. She wanted time to consider…

Age at interview 32

Gender Female

Age at diagnosis 31

View profile

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.

Sandra was disappointed to have LLETZ again because shed been told by a nurse that her results…

Age at interview 50

Gender Female

Age at diagnosis 48

View profile

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.1

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.

Footnote 1: 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.

Human papilloma virus (HPV)

Human papilloma virus (HPV) is a large family of viruses that affect the skin and mucous membranes that line the mouth and genital area. HPV...