Loop Excision of the Cervix - LLETZ

What is LLETZ (loop excision of the cervix)?

LLETZ (Large Loop Excision of the Transformation Zone) is a common and effective treatment used to remove abnormal cells from the cervix. It is often recommended if cervical screening (a smear test) or a biopsy has identified pre-cancerous changes that could develop into cervical cancer if left untreated.

This procedure uses a thin, loop-shaped wire with an electrical current to carefully remove the affected tissue. It’s quick, minimally invasive, and can often be performed in an outpatient setting, helping to protect your health and prevent further complications.

When is LLETZ recommended?

LLETZ is usually recommended if cervical screening or a colposcopy identifies abnormal cells on your cervix. These changes are often referred to as CIN (cervical intraepithelial neoplasia), which are graded based on how severe they are:

• CIN1: Mild changes, which may resolve on their own but may sometimes require treatment.
• CIN2 or CIN3: Moderate to severe changes that are more likely to progress to cervical cancer without treatment.

LLETZ may also be advised if abnormal glandular cells or other concerning changes are detected during investigations. By removing these cells early, the procedure helps to reduce the risk of developing cervical cancer in the future.

Preparing for LLETZ

Before your procedure, your gynaecologist will ensure you feel informed and supported. Here’s what to expect:

• Initial consultation: Your gynaecologist will explain why LLETZ is recommended, what the procedure involves, and answer any questions you may have.
• Practical advice: You may be advised to avoid using tampons, having sex, or swimming for 24 hours before the procedure to reduce the risk of infection.
• Managing anxiety: If you feel nervous about the procedure, let your healthcare provider know. They can discuss ways to help you feel more comfortable.

What happens during the procedure?

LLETZ is a straightforward procedure, typically performed under local anaesthetic. Here’s what you can expect:

• Anaesthetic: A local anaesthetic is applied to numb your cervix, ensuring the procedure is as comfortable as possible.
• Removing the abnormal cells: The doctor uses a fine wire loop to remove the affected tissue. This takes just a few minutes and is usually painless, although you might feel some pressure or a slight pulling sensation.
• Stopping bleeding: A special solution or gentle heat is applied to the area to stop any bleeding.

The entire appointment usually lasts about 15–20 minutes, and you can often go home the same day

Benefits of LLETZ

LLETZ is highly effective at removing abnormal cervical cells, offering several benefits:

• Prevents cervical cancer: By removing abnormal cells early, the procedure significantly reduces your risk of developing cervical cancer.
• Quick and convenient: The procedure is fast, often completed in one outpatient visit, with minimal recovery time.
• Protects your fertility: LLETZ is a fertility-preserving treatment, meaning you can still conceive and have children in the future.

Are there any risks?

LLETZ is generally safe, but like all medical procedures, there are some potential risks. These include:

• Bleeding: Light bleeding or discharge is common for up to 4 weeks, but heavy bleeding may require medical attention.
• Infection: Signs of infection include fever, increased pain, or foul-smelling discharge.
• Cervical stenosis: Rarely, the cervix may become narrowed, which can affect fertility or menstruation.
• Impact on future pregnancies: In rare cases, LLETZ may slightly increase the risk of preterm birth or miscarriage. Your doctor will discuss this with you if you plan to have children.
• Incomplete removal of abnormal cells: Occasionally, further treatment may be needed if all the abnormal cells were not removed.

Your doctor will explain these risks and address any concerns you may have.

Recovery after LLETZ

Recovery from LLETZ is generally quick, but it’s important to follow aftercare advice to help your cervix heal and minimise the risk of infection. Here’s what you should know:

• Rest and self-care: Most women feel well enough to return to normal activities within a day or two, but you may experience some light bleeding or discharge for up to four weeks.
• Avoid certain activities: To help the healing process, avoid swimming, heavy lifting, using tampons, or having sex until your gynaecologist gives you the all-clear (usually around four weeks).
• Managing discomfort: Some mild cramping or spotting is normal after the procedure, but over-the-counter pain relief can help if needed.

If you experience heavy bleeding, severe pain, or signs of infection (such as fever or an unpleasant-smelling discharge), contact your doctor promptly.