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Post 25, regular cervical screening is part of many people's medical routine. Often, cervical cells are completely normal and no further action is taken; you're usually asked to come back for another smear test in three years time. But in others, abnormal cells are detected and further treatment is needed. One such treatment is the LLETZ. But what is it, how does it work, and what are its side effects?
When I received the news I had to have a LLETZ procedure earlier this year, I was terrified. Much of the information available online was related to people's bad experiences - and many of my searches led me to cancer forums, which was anxiety-inducing in and of itself.
In reality, it was nothing like I'd feared.
LLETZ stands for 'large loop excision of the transformation zone'. It's the most common treatment for removing cell changes in the cervix.
If a smear test shows an abnormal result, you may be invited to have a colposcopy, a further examination where a doctor looks at your cervix and often takes a biopsy, a small sample of cervical tissue. If this biopsy shows cell changes, then your doctor might recommend that you have LLETZ, explains Imogen Pinnell, health information manager at Jo's Cervical Cancer Trust.
"Cell changes aren't cervical cancer, but having LLETZ makes sure the cell changes don't develop any further," she says.
You may also be told how severe the abnormalities are. Abnormal cells are often referred to as CIN (cervical intraepithelial neoplasia) - with CIN1 referring to mild changes, CIN2 to moderate and CIN3 to severe.
"It's dependent on this range and the location of the abnormal cells as to whether LLETZ is suggested as the best method of removing these cells," says Pierre Martin Hirsch, President of the British Society for Colposcopy and Cervical Pathology and spokesperson for the Royal College of Obstetricians and Gynaecologists.
What is the procedure like?
A LLETZ procedure starts out much like a regular cervical screening, with a speculum inserted into your vagina. A local anaesthetic is then injected into your cervix, meaning you're awake but the area being treated is numb.
A thin wire loop, through which an electric current is running, is then used to remove the area of the cervix where there are cell changes and to seal the cut at the same time. This should take around twenty minutes in total.
The operation shouldn't be painful. "Some people feel slight discomfort from the insertion of the speculum, and may feel some pain when the local anaesthetic injection is administered," says Martin Hirsch. "But you shouldn’t feel any pain during the excision of the cells - and you should let your doctor know if you do."
Martin Hircsh's advice bears out. During my procedure, I started to feel a small amount of pain; when I told my doctor, she immediately gave me another anaesthetic injection and the procedure carried on pain-free.
What are the side effects?
You may feel some cramping after the procedure - Pinnell likens this to period pain. "This is expected for a day or two after treatment," she says. "But it shouldn't be severe. If you're worried, it's important to let your doctor know so you can get the right care and support."
You may also experience bleeding and discharge for up to three to four weeks, though for some people this may stop as early as one to two weeks. You are advised not to have penetrative sex, use tampons or swim after LLETZ until bleeding has stopped. Recommendations vary when it comes to bathing - my doctor told me I was okay to bathe in a clean bath, whilst others recommend you try to avoid it until you've stopped bleeding. Check with your own doctor to work out what's best for you.
"But it’s really important to remember that everyone heals in different ways," Pinnell says. "Some people experience different side effects or for a longer time, and can feel unprepared if they're not made aware this is a possibility."
Other effects can include heavier or longer-lasting bleeding, Pinnell notes, but also "anxiety and changes to sex life".
Recent research from Jo's Trust also found that patients were often not warned of potential side effects, including impact on sex drive. They're arguing for better information and support for those going through procedures to remove abnormal cells.
"The diagnosis itself can have a profound psychological impact and there is a low level of awareness about this, despite there being support and treatments available for those affected," Pinnell says.
But keeping positive is key.
"It’s important to remember that most people who have LLETZ have a positive experience and the main benefit of having this treatment is that it can prevent the potential development of cervical cancer," she concludes.
What happens next?
"One of the benefits of LLETZ is that because the cells are removed rather than destroyed, they can be sent for further tests to confirm the extent of the cell changes and make sure all of the affected area has been removed," Pinnell explains.
She also notes that LLETZ is extremely effective - there's a success rate of around 90%, meaning that most people who go through with the procedure will have no further cell changes.
Results should take a few weeks to come back - sometimes slightly longer if additional tests are needed. This shouldn't be cause for concern. My results were even passed to a multidisciplinary team before I was given the all clear.
If the treatment has worked, you'll be asked to book an appointment for a follow-up in six months time; this will take the form of a routine smear test. And if this follow-up shows you're still clear of abnormal cells or HPV, you'll go back to having a smear test every three years.
Pathways can vary if the LLETZ is unsuccessful - sometimes further tests will be done, or the procedure will be repeated. In these cases, Martin Hirsch advocates speaking with your nurse or doctor about the options available to you.