Colposcopy clinics provide both diagnostic assessment and a range of targeted treatments for cervical abnormalities, primarily aimed at preventing progression to cervical cancer. Management typically depends on the severity of the abnormality and may include conservative monitoring for low-grade changes, or procedures such as large loop excision of the transformation zone (LLETZ) to remove abnormal tissue. In some cases, ablative therapies may be used.
Following a normal colposcopy without a biopsy, the woman will be discharged back to primary care for a repeat screening test in 3 years regardless of age.
If the woman has a biopsy showing CIN 1, she will be discharged to primary care for a repeat test in 12 months.
To access Colposcopy Algorithm 1 – management of people with HR-HPV positive & normal or low-grade abnormal cytology click here.
The evidence shows that it takes between 15-20 years for early cell changes to progress to actual malignancy so we can be confident that the woman can safely attend in 3 years for her next screening test.
To access the World Health Organisation’s Fact sheet on Cervical Cancer, click here.
The treatments performed in Colposcopy Clinics in Ireland are:
- LLETZ – Large Loop Excision of the transformation Zone
- Cold Coagulation
A LLETZ is a Large Loop Excision of the Transformation Zone. LLETZ is also called loop diathermy, loop cone, loop biopsy or loop excision. It involves removing the abnormal cells using a thin wire loop. This is heated with an electric current. In a small number of cases, a needle may be used to remove the cells instead of a loop.
A LLETZ can be done at the same time as a colposcopy
To access further information about the LLETZ treatment click here.
Common side effects of treatment include mild pain, light vaginal bleeding, watery vaginal discharge, a heavier than usual first period after treatment.
Serious complications: there is a small risk of more serious complications including post-procedure infection, which would cause heavy or persistent bleeding or smelly vaginal discharge. It can also cause a fever or constant tummy pain. These may require hospitalisation in a very small number of cases.
There is also a slightly increased risk of pre-term birth in future pregnancies, narrowing or closing of the cervix (cervical stenosis). In most cases, the benefits of treatment will outweigh these risks.
To access information about the risks and side effects of a LLETZ treatment click here.
It is a thermal (heat-based) ablative treatment to destroy pre-cancerous cells and is usually done under local anaesthetic in the colposcopy clinic as a day procedure.
To access information about Cold Coagulation, click here.
Common side effects of the treatment include mild pain, light vaginal bleeding, watery vaginal discharge, a heavier than usual first period after treatment.
Serious complications: there is a small risk of more serious complications including a narrowing or closing of the cervix (cervical stenosis) and a risk of infection which may require hospitalisation in a very small number of cases.
To access information about the risks and side effects of Cold Coagulation click here.
If a patient requires treatment i.e. Lletz or cold coagulation they should be advised to bring someone with them on the day of the procedure as they may not feel well enough to drive and may benefit from support. If a patient expects to have their period when treatment is due, they can contact the colposcopy clinic to discuss rescheduling.
Post LLETZ treatment advice
- May bleed for up to 4-6 weeks post treatment, it can be spotting or may be like a period. If
- bleeding heavier than a normal period the patient should follow advice of the treating
- clinician (some clinics advise to attending your GP or to return to the colposcopy clinic, gynae ward (out of hours) or Hospital Assessment Unit)
- No sex for 4-6 weeks
- No tampons for 4-6 weeks; use sanitary towels/pads
- No swimming pools/jacuzzis for 4-6 weeks
- Do not insert anything into the vagina for 4-6 weeks
- To have showers rather than baths for 4-6 weeks
- No vigorous exercise for a week
- If foul-smelling discharge present, advised to return to GP for treatment of possible infection
- Advised not to travel overseas for a month in case complications occur
- Some Colposcopy Clinics prescribe a course of prophylactic antibiotics
Post Cold Coagulation treatment advice:
- May have a watery bloody discharge for 4-6 weeks
- No sex for 4-6 weeks
- No tampons for 4-6 weeks: use sanitary towels/pads
- Do not insert anything into the vagina for 4-6 weeks
- No swimming pools/jacuzzis for 4-6 weeks
- To have showers rather than baths for 4-6 weeks
- If foul-smelling discharge present, advised to return to GP for treatment of possible infection
To access information regarding the advice post treatments, click here.