LEEP (LLETZ): Excisional Care for Cervical Dysplasia
A precise loop excision that removes the transformation zone, provides a pathology specimen, and treats confirmed high-grade changes.
The LEEP procedure—also called LLETZ (large loop excision of the transformation zone)—uses a thin wire loop with controlled electrical energy to remove a small, targeted portion of the cervix. It both treats abnormal cells and yields a specimen for pathology to confirm the grade of dysplasia and margin status. LEEP is commonly recommended for confirmed or highly suspected high-grade lesions (e.g., CIN 2–3) following colposcopy.
Fast Facts About LEEP
Excisional treatment that removes the transformation zone
Provides a pathology specimen to assess margins and grade
Typically performed in the office with local anesthesia
Procedure time is usually 10–20 minutes
Watery/bloody discharge is common for 1–3+ weeks
Who It May Help
- Confirmed CIN 2–3 or persistent high-grade findings
- Inadequate colposcopy with strong suspicion for high-grade disease
- Discordant results requiring diagnostic excision
- Select cases after prior treatment when residual disease is suspected
How It Works
After numbing the cervix with local anesthetic, a small wire loop excises the transformation zone in a controlled pass. A smoke evacuator removes surgical plume. Hemostasis is secured with cautery and/or a topical agent (e.g., Monsel’s). The removed tissue is sent to pathology to confirm the diagnosis and whether abnormal cells extend to the edges (margins).
Candidacy & Alternatives
LEEP is typically recommended for high-grade dysplasia or when diagnostic certainty is needed. We generally avoid LEEP during pregnancy unless cancer is suspected. Alternatives depend on findings and may include observation (for low-grade disease), ablative treatments (cryotherapy/thermal ablation) when criteria are met, or cold-knife cone excision when deeper or glandular involvement is suspected. Recommendations are individualized to your results, fertility plans, and guideline pathways.
LEEP vs. Other Options
LEEP (Excisional)
- Removes tissue and yields a specimen
- Office-based; quick recovery
- Useful when margins and grade must be confirmed
- Small risks: bleeding, infection, stenosis
Cryotherapy (Ablative)
- Destroys superficial tissue; no specimen
- Best when entire transformation zone is visible
- Less bleeding risk; watery discharge common
- Not ideal if canal involvement is suspected
Cold-Knife Cone
- Deeper, scalpel excision with operating-room anesthesia
- Preferred for suspected glandular disease or deeper lesions
- More recovery needs; specimen for full evaluation
- Used when cancer must be excluded
What to Expect
Most visits take 20–40 minutes including preparation. You’ll feel pressure and brief cramping; local anesthesia reduces discomfort. Afterward, expect watery/bloody discharge and possibly a dark or coffee-ground-like discharge from hemostatic agents. Use pads—not tampons—during healing. Avoid intercourse, swimming, hot tubs, and vigorous exercise until cleared, often ~2–4 weeks. Minor spotting can occur if a scab (eschar) loosens around days 7–14.
Safety & Considerations
Common effects include cramping, spotting, and watery discharge. Uncommon risks include heavier bleeding, infection, and cervical stenosis. Excisional treatments can slightly increase the risk of preterm birth in future pregnancies; we weigh benefits and risks and tailor the excision size to preserve cervical strength when possible. Margin status on pathology helps guide follow-up.
Before Your Visit
- ✓Bring recent Pap/HPV and colposcopy results
- ✓Schedule when you are not on heavy menstrual flow if possible
- ✓Avoid vaginal medications, intercourse, or douching for 24–48 hours before
- ✓Ask about taking an over-the-counter pain reliever 30–60 minutes prior
- ✓Tell us about bleeding disorders, anticoagulant use, or possibility of pregnancy
Frequently Asked Questions
1Does LEEP cure the abnormal cells?
LEEP removes the transformation zone and commonly clears high-grade lesions. Ongoing follow-up is still important to confirm clearance and monitor for recurrence.
2What do positive or negative margins mean?
Margins describe whether abnormal cells reach the edge of the removed tissue. Negative margins suggest complete excision; positive margins may warrant closer follow-up or additional treatment depending on your overall risk.
3How uncomfortable is the procedure?
Most patients tolerate LEEP well with local anesthesia. You may feel pressure and cramp-like sensations during and shortly after the procedure.
4What is the downtime?
Plan for watery or bloody discharge for 1–3+ weeks and pelvic rest for ~2–4 weeks, depending on healing and your clinician’s guidance.
5Will this affect future pregnancies?
Most people carry pregnancies normally after LEEP. There is a small increase in risk of preterm birth, which we minimize by tailoring excision size. Tell your obstetric team about prior cervical procedures.
6How will follow-up work?
You’ll have guideline-based HPV/cytology testing at defined intervals. Follow-up is essential—especially if margins were positive or if high-grade changes were confirmed.
Considering LEEP for Cervical Dysplasia?
We’ll review your results, confirm candidacy, and plan a precise excision with clear aftercare and follow-up so you know exactly what to expect.
Book an Appointment