LLETZ treatment of the cervix
LLETZ is a method of treating the cervix quickly and comfortably. They are recommended when pre-cancer changes are found in the cells of your cervix. LLETZ removes the abnormal area with an electrical wire loop (a diathermy loop). The removed tissue is then sent to the laboratory to be examined.
When a LLETZ is recommended
A LLETZ is recommended when a biopsy, or sometimes several smear tests, show pre-cancer changes in the cells on the cervix. These are also called 'high grade changes'.
This is not cancer. But at least 1 in 3 people who have these changes will develop cervical cancer if not treated. The development of cancer from high grade changes usually takes several years. However if cancer develops, more extensive treatment is needed.
Cervical cancer — Te Aho o Te Kahu Cancer Control Agency
When you cannot have a LLETZ
You cannot have a LLETZ if you are pregnant or have your period. Contact the clinic to reschedule if at the time of your appointment:
- you become pregnant
- your period is due.
How LLETZ is performed
You will have your LLETZ at a health clinic or in a hospital.
The person who schedules your treatment will give you instructions, such as:
- when to arrive
- what time you cannot eat or drink after.
It is important to follow these instructions.
On the day of your LLETZ, you will meet with your anaesthetist and the surgeon.
Your surgeon will do a colposcopy. They will then use the diathermy loop to complete the procedure. This takes about 5 to 10 minutes.
If you had a general anaesthetic, they will wait until you are asleep. You will be taken to a recovery area until you are able to go home.
When a general anaesthetic may be recommended
A general anaesthetic (when you are put to sleep) may be recommended over a local anaesthetic (when you are awake but the area is numbed) if:
- you have had difficulty with painful examinations before
- there were problems seeing the cervix in the clinic
- a larger area is needing to be treated.
Talk to your gynaecologist or healthcare provider if you are not sure why a general anaesthetic has been recommended.
What to expect after your LLETZ
You will need someone to drive you home. You will not be able to drive for 24 hours. It is usual to take 2 days off work — you can get a medical certificate, if needed, from your surgeon or healthcare provider.
Discharge and bleeding
You may have a watery discharge and some bleeding. Sometimes the discharge has dark flecks of tissue and may have a strong smell. This is part of the normal healing process. It may last for up to 3 weeks.
Your next period may be earlier or later than normal. It could be heavier than usual.
Cramps
You may have mild cramps for 1 to 2 days. These are similar to period cramps. You can take pain relief such as paracetamol or ibuprofen.
Heaving bleeding and infection
To avoid heavy bleeding or infection of your cervix, we recommend the following for 4 weeks after your LLETZ:
- do not have sex
- use pads, not tampons or menstrual cups
- have a shower instead of a bath
- do not go swimming or in spa pools.
Do not do strenuous exercise for 2 weeks.
Getting your LLETZ results
Your surgeon will write to you and your healthcare provider with the results from your LLETZ. These results can take up to a month to get. The letter will also tell you when your next cervical screening test is due.
Risks of a LLETZ
LLETZ is generally a very safe and simple treatment. It usually takes between 5 and 10 minutes, but if you have general anaesthetic it will take longer.
These are some possible risks of LLETZ.
Bleeding
This is usually minimal but occasionally requires admission, or a return to theatre if heavy.
Infection
This may require antibiotics.
Repeat treatment
Around 2 to 5% of people will need a second treatment.
Early (preterm) birth
Most people will have a normal pregnancy that carries to full term. Some people who have a LLETZ may have an increased chance of a future early birth. Additional monitoring in the first half of pregnancy may help to prevent this. It is important to let your midwife or doctor know if you have had a LLETZ treatment.
Scarring or narrowing of the cervix (cervical stenosis)
This can make it more difficult to get an accurate smear test. It is more common after menopause. You may need your cervix dilated.
Skin injury
Rarely, there may be injury to the vaginal skin.
Immunisation after LLETZ
Pre-cancer changes are caused by HPV. The LLETZ treatment removes the abnormal cells but it does not treat the virus.
Most people (around 90%) will clear the virus themselves with their own immune system within 2 years.
There is some research that shows having the HPV vaccine after LLETZ treatment helps reduce the chance of needing a second treatment. Immunisation for HPV is free until 27 years of age.