INFORMATION FOR L.L.E.T.Z TREATMENT UNDER LOCAL ANAESTHETIC

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1 Gynaecology Outpatients Department INFORMATION FOR L.L.E.T.Z TREATMENT UNDER LOCAL ANAESTHETIC INTRODUCTION If you have been diagnosed with having a cervical pre-cancerous cells which needs treating (not all abnormalities will require treatment), you will be offered a L.L.E.T.Z treatment, which stands for Large Loop Excision of the Transformation Zone. This treatment method removes a small area of your cervix containing the abnormal cells by using a diathermy loop. There is very little to worry about, as there is a good chance that the problem will be completely cured by just one treatment. For a very small number of patients, further treatment may be required at a later stage. The aim of the treatment is to remove the abnormal cells in the cervix and some of the underlying tissue. The treatment may easily be performed using a local anaesthesia to numb the cervix. In rare occasions, some patients may require a general anaesthesia. If this is necessary it will be discussed with you in clinic. The treatment itself will take only a few minutes. TREATMENT The treatment visit involves a short Colposcopic examination like the one you have already had. The local anaesthesia is then injected into the cervix. This is rather like the anaesthetic you may have had at the dentist (i.e. a very slender needle). Most patients find this almost painless. A heated wire loop is then used to remove the affected area. The cervix is numb by the stage and therefore you should feel no pain. There may be a period-like pain at the end of the procedure, but this will settle quickly or may be treated with a mild analgesic. Bleeding is minimal and easily controlled by the diathermy. The small crater that is left usually grows back to the normal shape over the next 6-8 weeks. Healing of the cervix occurs more quickly than this and is usually complete when the discharge stops POST TREATMENT There may be some discharge and spotting of blood during the first week. Then a period like bleed will occur for up to 6 weeks after. During this time we advise that nothing is placed inside the vagina (i.e. tampons). Sexual intercourse may resume when the bleeding has stopped. Your first period after the treatment may be different from your normal period and will probably be slightly heavier, but this should settle. HOLIDAY PLANS We advise you not to have the treatment if you are going abroad up to 6 weeks after the treatment. This is because there is a slight risk of infection as you will have some bleeding and discharge for approximately 4-6 weeks. Normal activities may resume after treatment Information For L.L.E.T.Z Treatment Under Local Anaesthetic Page 1 of 5

2 but it may be necessary to wear external pads but no tampons. It is advisable to take the day off work for the treatment but you can return to work the following day. PAIN AND DISCHARGE If you develop a foul-smelling discharge, significant pelvic pain or bleeding that is heavier than a period, you should contact your doctor or the Colposcopy department. If the procedure is performed under local anaesthesia, you will be fit to go home a few minutes after you treatment is completed. We advise that you have someone accompany you as you may not feel able to drive yourself. COIL If you have a coil (or IUCD/ Mirena IUS) then this need not be removed, prior to your treatment in colposcopy clinic. Practice amongst colposcopists is divided. Some colposcopists will consider removing it if you not had sexual intercourse for the preceding 5 days, but some colposcopists will perform a colposcopy and if a loop excision form of treatment is needed, then consider performing the loop around the coil and coil threads. Sometimes the threads are inadvertently cut but this is not a problem as a coil can be removed (when you no longer wish to use it) without the threads. FOLLOW UP After assessment of the specimen removed, we determine the degree of abnormality and whether it has been completely removed. We either arrange to see you again in the Colposcopy clinic (for a smear and Colposcopy) or you have a repeat smear at your GP surgery 6 months after your treatment. POST TREATMENT COMPLICATIONS Bleeding Vaginal bleeding is normal after your operation, the loss should be similar to a light period and can last up to six weeks. Only sanitary pads should be worn during this time. Internal protection such as tampons is an infection risk. During the time you are bleeding you should not pass large clots, soak more than two pads per hour or have sudden gushes of heavy blood loss. Should any of these symptoms occur, your emergency number will be Writtle Ward Discomfort Following the procedure, you may experience some discomfort. Please ensure you have pain relief at home should you require them like paracetamol or ibuprofen. A hot water bottle may also be an effective way of relieving discomfort. Infection Occasionally infection can occur following surgery, should this happen you will notice one or more of the following signs: Foul smelling discharge Vaginal itching/soreness Cramping abdominal pains Raised temperature Generally feeling unwell If you have any of the above symptoms please see your GP. Information For L.L.E.T.Z Treatment Under Local Anaesthetic Page 2 of 5

3 WOMEN'S QUESTIONS ANSWERED; PAIN No, the treatment will not hurt as we use a very fine needle that will make the area numb. This will not anaesthetise the vaginal wall skin, so you will feel the movement of the speculum, just the same as having your smear. After treatment you may experience some discomfort similar to period pains, this does not last very long and can be eased with simple analgesia like paracetamol or ibuprofen. BLEEDING Due to the healing process it may take 4-6 weeks to heal. It may start with a discharge then develop into a period like bleed. During this time it is advisable that you only wear sanitary pads as tampons can pose as an infection risk. FURTHER TREATMENT You will be invited to have a smear test at your GP surgery 6 months after treatment. The majority of ladies do not require any further treatment; however the result of your smear test will determine your future follow up. POST TREATMENT Light exercise is permitted but heavier exercise may cause further bleeding. Swimming should be avoided until bleeding and discharge has stopped. FUTURE ISSUES Any treatment involves a balance between removing abnormal cells on the one hand and minimising any possible harm on the other hand. Clearly the more of your cervix which has been removed then the less supporting tissue for future pregnancies. Your colposcopist will recognise the importance of the cervix to support future pregnancies and will tend to remove as little tissue as possible while making sure the treatment is successful. It is unlikely that women who have had one treatment for abnormal cells by loop excision will experience problems in future pregnancies. Those who have had multiple treatments may be at minor increased risk to deliver prematurely or preterm in later pregnancies. If you have had multiple treatments and are pregnant or considering a pregnancy then you should speak to your GP or obstetrician. While there currently appears to be no ideal way to judge this risk, your obstetrician or gynaecologist may advise a special scan early in pregnancy to measure the length of your cervix. In most cases this is normal but if not, your doctor may recommend a cervical stitch (or cerclage) to provide additional support. This is generally fitted when you are pregnant with a short general anaesthetic and removed whilst you are awake shortly before your baby is due. Information For L.L.E.T.Z Treatment Under Local Anaesthetic Page 3 of 5

4 PERIODS There is no evidence that the flow at menstruation is increased or that cycle regularity is altered by treatment. Rarely periods may disappear particularly after a cone biopsy (this is the treatment that is usually performed with a general anaesthetic) but this is due to a rare complication called cervical stenosis, where the cervix becomes blocked and cramp like period pains, continue because of blood becoming trapped in the uterus (or womb). This can usually be dealt with by a procedure to open the cervix and release the trapped blood. GENETICS There is no evidence that daughters and other female relatives of women with abnormal smears, pre-cancerous cells (CIN) or cervical cancer have an increased risk of abnormal smears, pre-cancerous cells or cervical cancer. Cervical smear abnormalities are common and it is not unusual for one or more family members to have had an abnormal smear, but there is no inherited predisposition to cervical abnormalities, CIN or cervical cancer HYSTERECTOMY A hysterectomy is rarely of any help to women with abnormal smears. Studies have shown that women who have hysterectomies (having the uterus or womb and the cervix removed) for pre-cancerous cells (CIN) are less likely to have pre-cancerous cells on the vagina but are not less likely to get a cancer (as the cervix will have been removed this would then be in the vagina). Gynaecologists are therefore careful before considering a hysterectomy for women with pre-cancerous changes in the cervix. It may be recommended after 2 or 3 local treatments have failed to remove a pre-cancerous problem, or if for technical reasons further smears cannot be taken from a cervix having had multiple treatments. Other women suitable for hysterectomy may have other difficulties such as heavy periods and abnormal cells making a hysterectomy a practical common solution. A hysterectomy may be recommended for an early cervical cancer. In all cases detailed discussion with your gynaecologist is required to decide whether you can have the hysterectomy as a vaginal, abdominal or laparoscopic (or keyhole) procedure and whether you should keep your ovaries or have them removed What is HPV and is my abnormal smear due to sex? There are 2 questions here. HPV or human papilloma virus is an extremely common virus that is almost always caught by sexual intercourse. Approximately 8 out of 10 adults have had the infection at some time and rarely produce any effects but only 5% of women will have abnormal smears. 1-2% will develop pre-cancerous cells (CIN) and a tiny minority of these progress to get cervical cancer despite the efforts of the screening programme. So although HPV is sexually transmitted it is not a sexually transmitted disease that requires a visit to a Sexual Health Clinic. The one visible abnormality some types of HPV can produce is warts on the vulva or the anus. This is a slightly different situation. These can be treated by the local Sexual Health Clinic. If you have these then your partner would also need examination and possible treatment. Usually a topical cream or freezing of warts is all that is required. Information For L.L.E.T.Z Treatment Under Local Anaesthetic Page 4 of 5

5 ADVICE POST TREATMENT After your treatment you may experience some period pain for up to 24 hours, painkillers (such as paracetamol of what you would normally use to ease pain) maybe taken to relieve this. There is an area on your cervix, which will need to heal. You may have some watery blood stained discharge for up to six weeks after treatment. During this time you should avoid sexual intercourse and the use of tampons. Pads should be used until the discharge settles. Where possible you should shower rather than bathe and swimming should also be avoided. The vagina is not a sterile environment and it is possible for the treated area to become easily infected. Please contact your GP if you experience a smelly discharge, heavy bleeding (i.e. using more than 5 pads per day) or painful cramps. Contacts / Further Information If you would like further information, regarding the evidence printed in this leaflet please contact the Colposcopy Department on or refer to: Please ask if you require this information in other languages, large print, easy read accessible information, audio/visual, signing, pictorial and change picture bank forma via the Patient Advisory Liaison Service (PALS) on (01245) Mid Essex Hospital services NHS Trust is smoke-free. You cannot smoke on site. For advice on quitting, contact your GP or the NHS smoking helpline free, Charitable donations can make a very real difference to the level of patient care at our Trust. As well as contributing to new facilities, donations can be used to buy specialist equipment and smaller items to make patient s stay in hospital more comfortable. For information about making a donation please contact the Charities Office on or visit the website at: Document History Department Colposcopy Published/Review: November 2014 / October 2017 File name Information For L.L.E.T.Z Treatment Under Local Anaesthetic Version/ref no 2.0 / MEHT Information For L.L.E.T.Z Treatment Under Local Anaesthetic Page 5 of 5

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