A-Z

Cervical Screening

Loop diathermy (LLETZ)

Loop diathermy, also referred to as LLETZ (Large Loop Excision of the Transformation Zone) is the most common treatment method used if the results of a cervical screening test (smear test) or colposcopy show moderate or severe cell changes (also known as LEEP outside the UK – Loop Electro-Excision Procedure). The abnormal cells are removed using a small loop wire which is heated electrically. The loop seals the area as it goes and the treated areas usually heal within a few weeks. Most women have this treatment at a hospital outpatient clinic and a local anaesthetic is used to numb the cervix. The treatment is quick and women will be able to go home afterwards. In some cases, where a large area of tissue needs to be removed or if women are very anxious, treatment is performed under general anaesthetic as a day patient.

We talked to women about their experiences of LLETZ. Some of the women we talked to were given this treatment at the same time as their colposcopy examination. Others had their treatment at a separate outpatient appointment. A few were admitted at a later date as a day patient.

 

Describes her experience of diathermy loop excision as a day patient.

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Age at interview: 42
Sex: Female
Age at diagnosis: 25
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It was a very minor procedure, it wasn't particularly disruptive at all and it was a day case, a very light anaesthetic. So you automatically afterwards, almost automatically you know you feel fine you don't feel as though it's been particularly invasive at all because, again because it's a general anaesthetic, it's all done and you've no idea what happens to you. I had no problems afterwards, in fact I don't think I actually had any bleeding or anything afterwards so it was almost as if I'd had nothing done apart from the sort of taking a day out to have a mild general anaesthetic. I was home by the afternoon, I think I went to the theatre something like about 11 o clock in the morning, I was home by 4, felt fine.

 

She had expected to have an opportunity to discuss her treatment before it took place.

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Sex: Female
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Yes in the sense that may be before the smear or even when I had the test and I had the treatment all we have is notification as in 'you have an abnormal result so we need to get the treatment' they say 'you have this, this and this type of treatment' but at the end of the day we don't get to choose. We go to the hospital, I was actually supposed to go and see a gynaecologist and I don't know what happened, I mean the appointment itself took over 6 months and they told me it was kind of not urgent but it was, it needed to be done in the near future so it took over 6 months for me to get the appointment and when I get the appointment they say "Oh you were supposed to go to gynaecology but we're going to do the treatment today." So I think I have an appointment to the gynaecology okay well you're having the treatment today I'm like what, you know so it was a bit like sudden. They don't consult you I don't think they do that is one of my objections I would have.

Although some women felt anxious about the clinical environment of the colposcopy examination many said they found it comforting to have the nurse holding their hand and talking to them during treatment. Others describe ways in which the atmosphere in the clinic helped them to feel comfortable and how they did not find the environment distressing, particularly if they had undergone childbirth or had previous treatments. A few were accompanied by a relative in the treatment room to provide moral support.

Most women found the local anaesthetic injection uncomfortable but not painful. A few women did not feel any discomfort.

 

Explains her experience of diathermy loop excision treatment.

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Age at interview: 37
Sex: Female
Age at diagnosis: 36
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Well, I went in to the room and it all looks very sterile and clinical and I had to get changed obviously and then the worst thing I think are the stirrups and thinking, well I don't know what you think really, just that I don't really want this done but I need to find out what's wrong. But one of the nurses held my hand the whole of the time and was just like stroking the back of my hand and saying, you know just talking to me in general and trying to find something out that I was interested in that we could talk about. Like for me I suppose its holidays so they hit on the holidaying and got me talking about different holidays that I'd had so that I wasn't as nervous. And, well they asked me if I wanted to look at the screen so that I could see what was being done but I didn't want to do that, I just kept my head turned but I suppose the option is there if you want to.
 

Paula didn’t feel any discomfort when she was given the local anaesthetic in her cervix during...

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Age at interview: 32
Sex: Female
Age at diagnosis: 31
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And I went into the clinic, the Colposcopy Clinic and what they do is they highlight the cells with a solution and any abnormal cells turn white or they turn a different colour, so they can see. And you can see it all on the screen while they are doing it as well. So she showed me on the screen. I had this big mass of white cells.
 
So what they did there and then was they used, they did a treatment called LLETZ and it’s basically they pass a hot wire loop through your cervix to remove the abnormal cells. It did sound quite scary, but it is not. It’s, you actually don’t feel it because you get anaesthetised before. They just pop an injection into your cervix, which you don’t feel either. I was really worried about that, I thought I might feel that. But I didn’t feel that at all.
 
And she sort of said, “Well I’ve done the, I’ve done the needle. Did you feel it?” I was like, “No, I didn’t feel a thing.”
 
So they did the treatment there and then and it was pain free. I will say it was pain free. I didn’t feel a thing. I think the worst thing is just having your legs up on the stirrups and having to be in that uncomfortable position. I found that the worst part about the whole treatment.
 
So she did the LLETZ treatment, but then she found some cells were going higher up the cervix and she couldn’t get them, at the clinic that day, under local anaesthetic. So what she did was took some biopsies, sent them away and she made an appointment for me to go back and see the consultant.
 
I went back to the consultant a week later and the biopsies had come back that I had CIN3, CIN 3, which is the severest form of cell change before they go to cancer. So happily for me it was caught early.
 
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Laura describes her experience of diathermy loop excision (LLETZ).

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Age at interview: 39
Sex: Female
Age at diagnosis: 37
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I went into a room and there was a nurse in there and she told me to undress and to lay on a bed, which then the sort of the bottom half drops down and your legs are up in the air, which isn’t very nice. But they were ever so nice and reassuring. My husband was with me at the time. He was sat with me, and then the consultant came in, and there was a camera next to me, and he just explained everything he was going to do. Gave me an anaesthetic which stung a little bit. And then they put this dye inside you and then the abnormal cells go white. And he could see that on the screen because he has got a camera that is looking into me, and then electronic pads were attached to me, to stop me from getting an electric shock from the [treatment]. And they just burn away the abnormal area and that was that really. Just tummy ache for the rest of the day.
 
And I bled. I bled for a little while, a few days afterwards and then back to normal straight away really.
 

Her diathermy loop excision treatment was straightforward and she advised women not to be afraid...

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Age at interview: 56
Sex: Female
Age at diagnosis: 55
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I mean that in itself didn't actually bother me because you're so used to as a woman having, once you've had children, you've had smear tests and everything you're used to that sort of examination so that, that in itself didn't really worry me. And it wasn't, okay you felt it, I felt it but it wasn't anything to you know scream out about or anything so there's nothing to be afraid of in that sense, I mean its, I think it's probably a relatively straightforward procedure so you know, just get on with it. Yes, I wasn't frightened about the actual, you know the actual procedure at all and I wouldn't say anybody needed to be frightened about the actual procedure its, yeah it's the least, least thing to worry about.

 

The anaesthetic felt unpleasant but it was not painful.

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Age at interview: 52
Sex: Female
Age at diagnosis: 46
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I remember, that's right she had to inject round the area I think and you could actually feel that. But I wouldn't describe it as pain, more the fact that you can feel something happening inside you which probably isn't a very, well it isn't a very pleasant feeling. But it can't be described as pain at all, just a not very pleasant feeling. 

During treatment, a few said they felt some discomfort. Several felt embarrassed and found the procedure undignified. Some found it useful to wear a skirt or a long top which enabled them to remove their undergarments but not feel exposed. Despite these feelings, most women commented that their experiences were not as bad as they had expected and they felt they were minor in comparison to the consequences of not undergoing treatment.

Immediately after treatment women can have some bleeding, which should not be heavy.

 

It helped to have leaflets which explained the kind of bleeding that might occur after diathermy...

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Age at interview: 52
Sex: Female
Age at diagnosis: 46
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I didn't go to work that week because I do quite a lot of lifting in my job so I stayed at home then. But I think more of a problem was trying to remember not to do things because I actually felt fine, I didn't have any problems at all.

I don't enjoy having a sort of constant bleed, but the leaflets that were given to me explained that you can bleed for quite a long time and it explained the difference between the sorts of bleeding you might expect and when to worry about it and when not to worry about it and I found that very helpful because you could just you know if you weren't sure about whether it should be fresh blood, or whether you should be passing sort of brown discharge or whatever you could just look at the leaflet and see. 

And that was fine, I felt very confident about all of that, didn't need to go and see my doctor, I just sort of carried on. And gradually over, I think it was I did bleed for quite a long time, two and a half weeks I think afterwards it sort of stopped and I really didn't have any problems at all. I had a slightly sore tummy, that sort of felt like it was just because you'd had somebody sort of messing about inside you, like perhaps very mild period pain probably is best described.

Some advised wearing suitable pants to the appointment because they would need to use sanitary towels rather than tampons for a short while. After treatment, several women said they felt some discomfort, like a low down period pain, others did not have any discomfort. One woman said she was in pain the next day and experienced heavy periods and painful cramps afterwards. Another went back to work immediately after her treatment and she said she felt fine.

 

She had a slight watering discharge for a while after diathermy loop excision.

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Age at interview: 57
Sex: Female
Age at diagnosis: 47
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Yes I think I was inclined to, it lingered on a bit I remember that, you did have a slight discharge for quite a little while, more a wetness than anything, I mean it was obviously quite clear but that went on for quite a while.

Was it longer than you were told?

Yeah well, no not longer than I was told but longer than I had hoped. Certainly longer than a heavy period and it just continued on, you know you were wearing liners etc for a little while. But I think that's just part of the, part of the treatment.

 

Paula had an infection after her LLETZ treatment which cleared up quickly with antibiotics.

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Age at interview: 32
Sex: Female
Age at diagnosis: 31
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I had minimal bleeding after the LLETZ and periods were a little bit up and down and I did actually have, this was another thing as well, I noticed after about a week a funny smell. And I was very concerned about that. Totally embarrassed to ask anybody about it, because you just think, well what’s going on? And I spoke to some of the girls from Jo’s, before my doctor, to go and get some reassurance and they all said, “Oh it sounds like you have got an infection. It is really, really common after you have a LLETZ treatment.
 
So I went to the doctor, on the advice of the girls from Jo’s, I went to the doctor’s and the doctors took a swab and they said, “Yes, you have got an infection. And it was just a course of antibiotics and it cleared it, it literally cleared it up within about two days.” That was probably about the only complication I had after. My bleeding was minimal, the pain after was minimal, nothing worse than a period pain, a very mild period pain.
 
So I think for me, the worse thing for me was the infection following the LLETZ, but I think that is quite common. It can happen.
Strapline' Paula had an infection after her LLETZ treatment which cleared up quickly with antiobiotics.
Key words' LLETZ, infection, bleeding, diathermy loop excision

A few who had their treatment as a day patient said that the light general anaesthetic which they had been given did not make them feel ill afterwards.

Women are advised to avoid certain activities after their treatment, such as swimming, sexual intercourse or heavy lifting. Most women found that after an initial abstinence they were well enough to resume these activities.

See more experiences of LLETZ.

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Last reviewed October 2015.

Last updated October 2015.

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