LEEP: Everything You Need to Know

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A loop electrosurgical excision procedure (LEEP) involves the removal of cervical tissue using a thin wire loop heated by electricity. This may be recommended to further evaluate and treat pre-cancerous cells on your cervix that are found during a screening Pap smear or colposcopy.

While this procedure is safe, fast, and performed in your doctor's office, follow-up and continued monitoring is key to ensuring that the abnormal cells do not return and progress to cervical cancer.

What Is a LEEP?

A LEEP is one of the most common procedures used to treat cervical dysplasia, which is when abnormal (precancerous) cells are found within or around a woman's cervix.

This procedure takes around 20 minutes and is performed in your doctor's office under local anesthesia.

After injecting a numbing medication into the cervix, the doctor inserts a thin, wire loop into the vagina. Once it reaches the cervix, an electric current is passed through the wire loop to cut away and remove a thin layer of abnormal cervical tissue.

Besides a LEEP, other procedures that may be used to remove abnormal cervical cells include:

  • Laser or cold knife conization: The abnormal cervical tissue is cut and removed with a laser or scalpel, respectively.
  • Cryotherapy: The abnormal cervical tissue is destroyed with cold temperatures.
  • Laser or thermal ablation: The abnormal cervical tissue is destroyed with a laser or heated metal probe, respectively.

Your doctor will decide on a LEEP or another procedure based on factors like your age, the location of the abnormal cells in your cervix, the size and number of areas affected, their suspicion for cancer, and whether you have undergone prior cervical treatments.

Contraindications

Severe cervicitis (inflammation or infection of the cervix) is a contraindication to a LEEP.

A LEEP is also not performed during pregnancy unless there is a high suspicion of cervical invasive cancer.

Potential Risks

Risks associated with a LEEP include:

  • Heavy bleeding
  • Burning of the vagina
  • Infection
  • Scarring and narrowing of the cervix (may cause problems with menstruation)

After a LEEP, there is also a small increase in the risk of future pregnancy complications, including premature birth and having a low-birth-weight baby.

Purpose of a LEEP Procedure

A LEEP is typically done when a Pap smear or a colposcopy suggests the presence of abnormal cervical cells or cervical dysplasia.

Cervical dysplasia may be a precursor to cervical cancer and is often caused by a human papillomavirus (HPV) infection. The good news is that when cervical dysplasia is identified and treated early, most women do not go on to develop cancer.

While a LEEP can remove abnormal cervical cells, it is not a cure for HPV. Even if the cells are cleared, you will still have HPV and require ongoing monitoring to ensure that any abnormal cells are treated promptly if and when they emerge.

Less commonly, a LEEP may be used to help diagnose or treat the following conditions:

  • Cervical polyps
  • Genital warts
  • Diethylstilbestrol (DES) exposure in daughters of mothers took this synthetic form of estrogen when they were pregnant, as they are at an increased risk for developing cancer of the cervix and vagina

How to Prepare

If your doctor tells you that you need to undergo a LEEP, they will likely ask you to schedule the test when you are not menstruating. This will allow for optimal visualization of your cervix.

Once you are scheduled for a LEEP, your doctor will give you instructions on how to prepare.

Location

The LEEP procedure is performed by a gynecologist in their office.

What to Wear

You will need to change into a hospital gown for your LEEP. As such, it's a good idea to wear loose-fitting, comfortable clothes that are easy to remove on the day of your procedure.

Food and Drink

You do not need to abstain from food or drink prior to a LEEP.

Medications

If you take aspirin, or another type of blood thinner, your doctor might ask you to stop or decrease the dose before your LEEP.

Be sure to tell your doctor all of the drugs you are taking, including prescription and over-the-counter medications, herbal products, vitamins, and recreational drugs.

Your doctor may advise you to take four regular-strength Motrin (ibuprofen) tablets or two extra-strength Tylenol (acetaminophen) tablets one hour prior to a LEEP (assuming you are not allergic to these drugs). This can help ease the mild discomfort you may feel during the procedure.

What to Bring

Items to bring with you on the day of your LEEP include:

  • Your driver's license and insurance card
  • A sanitary pad to wear home after the procedure (pinkish or dark-brown discharge is common after a LEEP)
  • A comfortable pair of pants to go home in (some mild, temporary cramping may persist after the procedure)

Pre-Op Lifestyle Changes

Your doctor will advise you to not have sex, douche, or use tampons or any vaginal creams or medicines 24 hours before the procedure.

What to Expect on the Day of the Procedure

While a LEEP is a short procedure, it's natural to feel uneasy about it. It may help you to know what to expect, from start to finish.

What to Expect During a Loop Electrosurgical Excision Procedure
Verywell / JR Bee

Before the Procedure

Upon arrival at your doctor's office for a LEEP, you will be asked to use the bathroom to empty your bladder. In the exam room, you will then undress from the waist down and put on a gown.

During the Procedure

When it's time to begin the procedure, you will be asked to get on the exam table, put your feet in the stirrups at its end, and lie on your back.

Your doctor will then proceed with the following steps:

  • Cervix visualization: Your doctor will insert a speculum into your vagina and then open it to get your cervix in view. The doctor will next place a colposcope near (but still outside) your vaginal opening. This special instrument allows for a magnified view of your cervix. The doctor will also apply a diluted acid or iodine solution to the cervix to make the abnormal cells turn white and be more visible. The application of this solution may cause a mild burning sensation.
  • Cervix numbing: Using a small needle, the doctor will inject the cervix with the numbing medication. You may feel a pinprick or stinging sensation during this process.
  • Abnormal cervical cell removal: A wire loop is then inserted through the speculum and moved toward the cervix. The electrical current sent to the wire allows it to heat up and quickly cut away the affected cervical tissue. You may feel mild cramping or pressure while this is happening. Some women feel faint; be sure to tell your doctor if this happens to you.
  • Prevent/stop cervical bleeding: After the abnormal cells are removed, the doctor will cauterize the cervix using a special medical paste to control any bleeding (which is generally minimal).
  • Speculum removal: The doctor will remove the speculum. You will be assisted up on the table and asked to get dressed for recovery at home. The removed cervical tissue will be sent to a special laboratory for testing.

After the Procedure

You may feel a deep, dull pain after the procedure due to the small wound created in the cervix. You will have some time to rest, use the restroom, and place a sanitary pad.

After you discuss any questions or concerns that you have about your procedure or recovery, you can leave your physician's office.

Recovery

After a LEEP, your doctor will give you various instructions to follow at home.

These instructions generally include:

  • Take pain medication (usually an over-the-counter medication like Tylenol) for any mild discomfort or cramping you experience.
  • Wear a sanitary pad for any vaginal spotting and/or vaginal blood or dark-brown discharge. This spotting/discharge is normal for one to three weeks after a LEEP.
  • Avoid sex or placing anything, including tampons, in your vagina for three to four weeks.
  • Avoid strenuous activity for 48 hours. Aerobic exercise and heavy lifting should be avoided for longer (at least one to two weeks after your LEEP).
  • Showering is OK after a LEEP, but avoid baths for two to four weeks after the procedure.

When to Call Your Doctor

Call your doctor if you experience any of the following symptoms:

  • Fever or chills
  • Heavy vaginal bleeding or bleeding with clots
  • Foul-smelling vaginal discharge
  • Severe abdominal pain


Long-Term Care

You will have a follow-up appointment about two weeks after your LEEP to review the cervical tissue results from the laboratory.

Be sure to follow up with your doctor about your results if you do not hear back from them/don't already have this appointment scheduled. Don't assume that no news is good news.

If the cervical dysplasia has been adequately treated (i.e., all of the abnormal cells have been removed), your doctor will still want to see your more frequently to start. Depending on your doctor and your case, can expect to undergo a Pap smear and HPV test every six to 12 months for one to two years.

The purpose of these tests is to ensure that the dysplasia does not return. If all the follow-up test results are normal, you may be able to return to normal, routine screenings every three years.

If the margins are positive (meaning the edges of the tissue sample contain abnormal cells), then a colposcopy, Pap test, and an endocervical curettage (when the lining of the canal inside the cervix is scraped to obtain a tissue sample) is required in six months. This is followed by a Pap plus a high-risk HPV test every six months to a year.

If all these tests are normal, you may be able to resume normal, routine screenings.

Strategies for follow-up after a LEEP vary slightly among doctors. That said, the overall goal of these tests is to maximize the prevention of cervical cancer while minimizing the harm of overtesting and overtreating.

Possible Future Procedures

If any of the follow-up tests show cervical dysplasia, a LEEP or other excisional or ablative procedure (for example, laser conization or cryosurgery, respectively) may be required. In some cases, if the abnormal cells persist, a hysterectomy may be recommended.

If cancer cells are ever found, imaging tests will be ordered to determine if and how far the cancer has spread. You will also be referred to an oncologist. Treatment of cervical cancer involves surgery, radiation, and/or chemotherapy.

Lifestyle Adjustments

The following lifestyle practices can help prevent cervical cancer:

  • Get the HPV vaccine: While the HPV vaccine is recommended for all children between the ages of 9 and 12, it can be given to females age 13 through 26 (and males age 13 through 21) who have not yet been vaccinated.
  • Limit the risk of contracting HPV: HPV is spread through skin-to-skin contact. While using condoms during sex is advised, keep in mind that HPV can still spread through contact with parts that a condom doesn't cover.
  • Stop smoking: Smoking increases your risk for cervical pre-cancer and cancer.

A Word From Verywell

Even though a LEEP is a safe, straightforward procedure that treats pre-cancerous cell changes on the cervix well, it's normal to feel a bit nervous about having one done.

If your doctor has recommended a LEEP, try to remain calm and focus your thoughts on how this procedure will help you stay healthy and cancer-free. Also, do not hesitate to ask your doctor questions or relay any concerns you have.

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Article Sources
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