Colposcopy - Treating abnormal cells in the cervix

You may need treatment if the results of your colposcopy show that there are abnormal cells in your cervix.

The abnormal cells will be removed, which usually involves removing an area of the cervix about the size of a finger tip.

The type of treatment depends on the number of abnormal cells in your cervix and how advanced the abnormalities are.

The aim is to remove the abnormal cells while minimising damage to healthy tissue. Treatment has about a 90% success rate.

Timing of treatment

It's often possible to have treatment at the same time as your colposcopy.

Some more intensive treatments can't be done on the same day as a colposcopy. Your colposcopist can discuss treatment options with you, and what each type of treatment involves.

Some available treatments are discussed below.

Large loop excision of the transformation zone

In the UK, large loop excision of the transformation zone (LLETZ) is the most common treatment for abnormal cervical cells. LLETZ is also known as loop diathermy, loop cone, loop biopsy or loop excision.

The “transformation zone” is the junction between the skin on the surface of your cervix and the delicate tissue that lines the birth canal at its entrance. This is the area where the majority of abnormalities occur and is where HPV creates changes to the cells.

LLETZ can be carried out at the same time as a colposcopy and involves removing the area of the cervix where abnormal cells are. This is done using a thin wire loop that's heated with an electric current.

LLETZ takes 5-10 minutes and is usually carried out as an outpatient procedure, which means you won't need to stay in hospital overnight. A local anaesthetic is usually injected into the cervix to numb the area. However, you may experience some mild pain, similar to period pain.

If a larger area of the cervix needs to be treated, the procedure will take longer and you may need a general anaesthetic.

You'll need to bring a sanitary towel with you, as you'll bleed after having LLETZ. You may have light bleeding for several weeks after the procedure.

After having LLETZ, you should avoid:

• using tampons for four weeks (use sanitary pads instead)
• having sex for four weeks
• exercising, including swimming, for at least two weeks, or while there's still any bleeding or discharge 

These all increase your risk of developing an infection after the procedure. 

There's some evidence to suggest that women treated with the LLETZ procedure have an increased risk of premature birth in future pregnancies. However, in most cases, the benefits of treatment will greatly outweigh this small risk. Your doctor can advise further about this, if necessary.

Cone biopsy

It's not possible to carry out a cone biopsy at the same time as a colposcopy. A cone biopsy is a minor operation that may require an overnight stay in hospital. It's not carried out as often as LLETZ and only tends to be used if a large area of tissue needs to be removed.

A cone biopsy is carried out under general anaesthetic. A cone-shaped piece of tissue is removed from your cervix using a scalpel. The tissue will then be sent to a laboratory for closer examination.

Following a cone biopsy, a dressing (pack) may be placed in your vagina to help stop any bleeding.

It's normal to bleed for up to four weeks after having a cone biopsy. You may also have some period-like pain, although any discomfort should only last for a couple of hours.  

Other treatments

Abnormal cells can also be treated in a number of other ways. Your doctor can give you advice about the procedures outlined below:

• Cryotherapy – where the abnormal cells are frozen and destroyed.
• Laser treatment – a laser is used to pinpoint and destroy abnormal cells on your cervix.
• Cold coagulation – a heat source is applied to the cervix to burn away the abnormal cells.
• Total hysterectomy (surgical removal of the womb) – this will only be considered if abnormal cells on your cervix have been found more than once or if they're severely abnormal.

After treatment

Following a cone biopsy, you'll probably be advised to avoid:

• using tampons for four weeks (use sanitary pads instead)
• having sex for four weeks
• exercising, including swimming, for at least two weeks, or while there's still any bleeding or discharge

Your GP or staff at the clinic will be able to answer any queries or discuss any concerns you may have about your colposcopy or treatment.

Cervical screening and HPV testing following treatment for abnormal cells

Six months after your treatment for abnormal cervical cells, you should have a cervical screening test.

The test will be carried out to check for the presence of abnormal cells and the human papilloma virus (HPV). If some mildy abnormal cells are found but the virus is no longer present, it's highly likely that the condition has been cleared from your cervix.

If HPV isn't found, you won't need to be screened for another three years. However, if HPV is found, or if more significant cell changes (moderate or severe) are detected again, you should be referred for another colposcopy.

Risks of removing abnormal cervical cells

Removing abnormal cervical cells is an effective way of preventing cervical cancer. However, there are some risks associated with the treatment.

There's a risk of developing an infection after having cells removed.  See your GP if you have:

• heavy or persistent bleeding
• a smelly vaginal discharge
• persistent tummy pain

There's also a slightly higher risk of having a baby prematurely if you get pregnant after having cells removed from your cervix.

Not all women with abnormal cervical cells will need treatment to remove them. However, all women with serious cell abnormalities will be offered treatment to have them removed.

Not all serious cell changes will develop into cancer, but it’s impossible to tell which will and which won’t. You'll be advised to have the abnormal cells removed anyway, just in case.