LEEP

Most LEEP procedures can be performed in the office using local numbing medication. In some situations, we may recommend performing the procedure in the operating room, particularly if the cervix is difficult to visualize or access safely. If your LEEP is scheduled in the operating room, you will receive separate instructions about fasting, medications, anesthesia, and arrival time.

If your LEEP is being performed in the office:

• Try to avoid scheduling during your period when possible. Light spotting is usually okay, but heavier bleeding can make it more difficult to see and treat the cervix. If your period starts before your appointment and you are having more than light bleeding, please call our office so we can determine whether your procedure should be rescheduled.

• We will usually ask you to provide a urine sample for a pregnancy test before the procedure. Please let us know if you are pregnant or think you could be pregnant.

• You may take ibuprofen (Motrin/Advil) or acetaminophen (Tylenol) about 30–60 minutes before your appointment if you normally take these medications safely.

• Eat and drink normally before your appointment. There is no need to fast for an office LEEP.

• Consider bringing a pad or panty liner to use afterward.

• You are welcome to bring a support person if that would make you more comfortable.

• Most patients are able to drive themselves home after an office LEEP.

An office LEEP usually takes about 10-15 minutes, although the portion of the procedure that removes the abnormal tissue is quite brief.

1. Getting positioned
You'll lie on the exam table just as you would for a pelvic exam. A speculum is placed in the vagina so that we can see your cervix.

2. Identifying the area to be treated
We examine the cervix and may apply solutions similar to those used during your colposcopy to help identify the area of abnormal cells.

3. Numbing the cervix
Local anesthetic is injected into the cervix to numb the area before tissue is removed. The numbing medication often contains epinephrine, which helps decrease bleeding. You may feel a brief pinch or cramping with the injection, and some patients notice temporary symptoms such as a faster heartbeat or feeling shaky from the epinephrine.

4. Removing the abnormal tissue
A thin wire loop is passed through the area of the cervix containing the abnormal cells. Electrical energy allows the loop to remove the tissue while helping control bleeding. The actual removal usually takes only a few seconds. You may feel pressure or mild cramping, but you should not feel sharp pain.

5. Controlling bleeding
After the tissue is removed, we carefully check the cervix for bleeding. Cautery and/or a medication such as Monsel's solution may be applied to the treatment area to help control bleeding.

6. Sending the tissue to the laboratory
The tissue removed during the LEEP is sent to a pathologist for examination. This allows us to confirm the diagnosis and evaluate whether abnormal cells extend to the edges, or margins, of the specimen.

The main benefit of a LEEP is that it removes high-grade precancerous cells before they have the opportunity to progress to cervical cancer. The tissue that is removed is also sent to the laboratory, where it can be examined more closely to confirm the diagnosis and help determine whether the abnormal area was completely removed.

LEEP is generally a safe and effective procedure, but there are some potential risks:

• Bleeding or infection: Some bleeding and discharge are expected while the cervix heals, but significant bleeding or infection is uncommon.

• Cervical stenosis (narrowing of the cervix): As the cervix heals, scar tissue can occasionally cause the opening of the cervix to become narrower. Most patients do not experience this complication, but if significant narrowing occurs, it can sometimes interfere with menstrual flow or make it more difficult to pass instruments through the cervix for future procedures.

• Future pregnancy: A LEEP removes a small portion of cervical tissue. In some patients, this can make the cervix slightly shorter or weaker, which may increase the chance that the cervix opens or shortens too early during a future pregnancy (cervical insufficiency) or that a baby is born prematurely. The overall risk is generally small after a single, uncomplicated LEEP and is greater when a larger amount of cervical tissue is removed or when someone has had more than one excisional procedure.

If you hope to become pregnant in the future, this does not mean that you should avoid a LEEP when treatment is recommended. We take future pregnancy plans into consideration and try to remove the tissue needed to appropriately treat the abnormal cells while preserving as much healthy cervical tissue as possible.

Most patients are able to return to their usual daily activities fairly quickly after a LEEP, although the cervix takes several weeks to completely heal.

It is normal to experience:

• Mild cramping for several hours after the procedure. Ibuprofen (Motrin/Advil) or acetaminophen (Tylenol) can be used if needed.

• Light bleeding or spotting that may come and go during the healing process.

• Watery or blood-tinged vaginal discharge for several weeks as the cervix heals.

• Dark brown, black, or coffee-ground-like discharge if medication such as Monsel's solution was applied to the cervix. This is normal.

• Occasionally, a temporary increase in bleeding about 1–2 weeks after the procedure as the treated area continues to heal.

For the first week:

• Avoid strenuous exercise, running, heavy lifting, or other vigorous activity.

• Walking and normal daily activities are fine as you feel comfortable.

• After the first week, you can gradually return to your usual exercise as long as you are not having increased bleeding or discomfort.

For 4 weeks while the cervix heals:

• Avoid intercourse, tampons, and anything else inside the vagina.

• Avoid swimming, hot tubs, or soaking in a bathtub. Showering is fine.

• Use pads or panty liners for any bleeding or discharge.
  
  

Your pathology results are typically available within 3–5 days. We will review the tissue removed during your LEEP and let you know if there are any findings that require attention before your follow-up visit.

We will typically see you back in the office about 4 weeks after your LEEP. At this visit, we will make sure your cervix is healing appropriately, review your pathology results in more detail, and discuss when you can resume normal activities and what cervical cancer screening or follow-up will be needed going forward.

The tissue removed during your LEEP is sent to a pathologist for examination. The pathology report helps us confirm the degree of cervical dysplasia and determine whether the abnormal area appears to have been completely removed.

One important part of the report is the margins, or edges of the tissue that was removed:

• Negative (clear) margins mean that abnormal cells were not seen at the edges of the specimen. This is reassuring and suggests that the abnormal area was removed.

• Positive margins mean that abnormal cells extend to one or more edges of the specimen. This does not necessarily mean that another procedure is needed. Depending on your results and individual circumstances, we may recommend closer follow-up, additional testing, or occasionally further treatment.

Even when the abnormal cells appear to have been completely removed, continued cervical cancer screening is important. Having a history of high-grade cervical dysplasia means that you will need closer follow-up than someone who has never had an abnormal result.

Your exact follow-up plan will depend on your pathology results and previous cervical screening history. We will review this with you and make sure you know when your next Pap and/or HPV test should be performed.