The treatment for CIN partly depends on its grade.
Often, cells showing CIN 1 will return to normal without any treatment at all. If your colposcopist decides not to treat these minor changes, they’ll arrange for you to have further screening tests. This is to make sure that any further changes that may occur are quickly recognised.
Most doctors and researchers agree that CIN 2 and 3 should be treated. The aim of treatment is to remove the abnormal area, while causing as little damage as possible to surrounding healthy tissue. It’s also possible to destroy the abnormal cells, rather than remove them, although this isn’t commonly done.
Ways of removing the abnormal area include:
large loop excision of the transformation zone (LLETZ)
a cone biopsy
a hysterectomy or trachelectomy, although this is rare.
Ways of destroying the cells in the abnormal area so that normal cells can grow back in their place include:
These procedures are all explained below. Currently, LLETZ is the most commonly used method of treatment.
How treatments are given
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Most women only need one of the treatments described here. All of the treatments are usually very effective at removing the abnormal cells. The type of treatment you have will depend on a number of factors. These will include the facilities available at your local hospital, and the type of treatment that your doctor thinks is best for you.
It may be possible for the treatment to be done at the same time as your initial colposcopy appointment, or you may have to come back at a later date.
LLETZ, laser therapy, cryotherapy, cold coagulation and sometimes cone biopsies are carried out in a hospital outpatient clinic using a local anaesthetic. This means that you can go home after treatment. It can be helpful for someone to either come with you while you’re having the treatment or pick you up afterwards.
Before your treatment, the nurse will help you lie comfortably on the couch. The colposcopist will then use a speculum so that they can see your cervix.
Try to relax as much as possible and don’t be afraid to ask the colposcopist any questions about your treatment. The treatment itself is likely to take around 5-10 minutes and although it may be uncomfortable, it isn’t painful.
The different types of treatment
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Large loop excision of the transformation zone (LLETZ)
LLETZ is the most commonly used treatment for removing abnormal cells from the cervix
. It’s sometimes called LEEP (loop electrosurgical excision procedure). It takes about 5-10 minutes and is usually done under local anaesthetic as an outpatient procedure. Sometimes, if a larger area of the cervix is treated, a general anaesthetic may be used.
Once you’re in a comfortable position, the colposcopist will put some local anaesthetic into your cervix to numb it. They’ll then use the colposcope to see a magnified image of your cervix and, with a thin wire loop, remove the abnormal tissue. The loop is heated with an electric current, which cuts and seals the tissue at the same time. This shouldn’t cause any pain although you may feel some pressure inside your cervix.
The tissue will be sent off to a laboratory to be checked and to confirm the type of abnormal cell changes. Depending on the result, your colposcopist will decide whether you need to be followed up either at the colposcopy clinic or with your GP.
LLETZ is not usually painful, but you may experience a period-like pain or a burning sensation. After the treatment you may have some light bleeding or discharge, which can last for around four weeks. Your doctor or nurse will give you more information about what to expect after your treatment. LLETZ will not affect your ability to enjoy sex once your cervix has healed. But you should avoid sex, swimming, tampons and baths until the cervix has healed and any bleeding has stopped. Your colposcopist will give you more information about this.
This is another treatment for CIN that involves removing abnormal tissue from the cervix.
A cone biopsy is usually carried out under a general anaesthetic, but sometimes a local anaesthetic may be given. The doctor uses a scalpel to take a small, cone-shaped piece of tissue from the cervix, which will be examined under a microscope. Afterwards, a small pack of gauze (like a tampon) may be put into the vagina to prevent bleeding.
This is usually removed within 24 hours before you go home. Some women may also have a tube (catheter) put into the bladder to drain urine while the gauze pack is in place.
It’s normal to have some light bleeding and discharge for around four weeks. You should avoid any sex and strenuous exercise for at least four weeks to allow the cervix to heal properly.
Sex after LLETZ or a cone biopsy
Neither LLETZ or a cone biopsy will affect your ability to enjoy sex once your cervix has healed.
Fertility after LLETZ or a cone biopsy
Very rarely, the cervix can become tightly closed after treatment. This is known as stenosis. It can make it harder for the sperm to enter the womb and so can affect your chances of becoming pregnant naturally (your fertility). Your cervix is not completely closed if you’re still bleeding during your periods.
Pregnancy after LLETZ or a cone biopsy
Sometimes treatment can make the cervix slightly weaker. This is unlikely with a single treatment, but if you need more than one treatment the cervix may weaken. Very rarely, this may mean that towards the end of a pregnancy when the baby is bigger, the weakened cervix may start to open early causing a premature birth. To stop this happening, a stitch may occasionally be put into the remaining part of the cervix during pregnancy. The stitch is removed before you go into labour. Your doctor will discuss this with you in more detail if you’re concerned about future pregnancies.
Laser therapy or laser ablation
Under local anaesthetic, a laser beam is directed at the abnormal areas of your cervix and the cells are destroyed. During the treatment you may notice a slight burning smell from the laser. This is normal.
This is a misleading name as the abnormal cells are removed by heating, not cooling. Firstly, a local anaesthetic is given to numb your cervix, then a hot probe is placed onto its surface.
You’ll be given a local anaesthetic, and a probe will be put in your cervix to freeze the abnormal cells. Cryotherapy has a slightly lower success rate than the other treatments for CIN, and so it’s not often used.
Hysterectomy or tracheloctomy
These types of surgical treatment are rarely needed for CIN.
A hysterectomy is an operation to remove the womb and cervix. It’s sometimes done for persistent or severe CIN if women have other gynaecological problems and are past childbearing age, or don’t want to have more children. Your doctor may discuss with you whether to remove your ovaries during the surgery. For women who’ve not yet had the menopause, removing the ovaries will bring on an early menopause.
Instead of having a hysterectomy, it’s sometimes possible to have an operation where the cervix is removed and the womb is left in place. This type of operation is known as a trachelectomy. Because the womb is left in place, it’s still possible to become pregnant after this operation. A trachelectomy is mainly carried out in younger women who still want to have children. Your doctor will be able to give you more information about whether this type of surgery is suitable for you.
Unless you’ve had a hysterectomy, trachelectomy, or possibly an LLETZ or cone biopsy under a general anaesthetic, you’ll be able to go home on the day that you’re treated.
Most women feel fine after treatment to the cervix, which involves a local anaesthetic, but some women feel slightly unwell for a few hours. It’s a good idea to have the day off work, in case you need to go home and rest. Many women find it helps to bring a relative or friend to support them and drive them home.
If your treatment was done under local anaesthetic, you may have some period-like pains for the rest of the day once the anaesthetic has worn off. You should expect to have some bleeding or discharge after these treatments. This usually stops within four weeks but may last up to six weeks. The bleeding shouldn’t be heavier than a moderate period and should get steadily lighter.
You should contact your GP or the clinic where you had your treatment if:
the bleeding starts to get heavier - for example, completely soaking a pad within two hours
the discharge starts to smell offensive, which can mean that you have an infection
you develop a temperature
you have severe pain
you have any other concerns.
Your doctor or nurse will probably advise you not to have sex for at least four weeks after your treatment to allow the cervix to heal properly. You may also be advised not to use tampons for four weeks. You should feel completely back to normal within about six weeks.
Research has shown that treatments for CIN are usually very successful. Although most women will have no further problems and the CIN will not come back, all women still need to continue with regular cervical screening tests.
If you have no treatment
If your colposcopy shows you have CIN 1 and your colposcopist decides not to treat these minor changes, you’ll usually have a repeat screening test after six months. This is to make sure that more cell changes don’t take place.
If you have treatment
You’ll be invited to have a follow-up screening test six months after your treatment. This is to make sure that the treatment has been successful and that the abnormal cells haven’t come back.
Moderate or severe cell changes
If your follow-up screening test shows that abnormal cells have come back, and you have moderate or severe cell changes, you’ll be referred for another colposcopy.
Normal, borderline or mild cell changes
If your follow-up screening test shows that you have normal, borderline or mild cell changes, what happens next depends on whether HPV testing is carried out in the area where you live:
If HPV testing isn’t carried out in the area where you live - After your six-month, follow-up screening test, you’ll usually have a further screening test 12 months after treatment. If both these tests are normal, you may continue with yearly screening tests for a period of time and then go back to routine tests every 3-5 years (depending on your age). If any of your tests show abnormal cells, you’ll be referred back to the colposcopy clinic.
If HPV testing is carried out in the area where you live - Your sample from your six-month, follow-up screening test will be checked to see if the HPV infection has gone or if you have a high-risk HPV infection. If high-risk HPV is found, you’ll be referred for another colposcopy. If it isn’t, you’ll be screened again in three years’ time.
Treating abnormal cells that come back
For most women, treatment for CIN is very successful. However, for some women, the abnormal cells can come back. If this happens, you’ll be invited for another colposcopy and further treatment if necessary.
Very occasionally, if the abnormal cells continue to come back after treatment, some women are advised to have a hysterectomy or trachelectomy (see above) to prevent them from developing cancer of the cervix. Your doctor will discuss the most suitable treatment options with you.
Even if you’ve had a hysterectomy or trachelectomy, you’ll still need to have regular check-ups using liquid-based cytology. The sample of cells will be taken from the top of the vagina. This is sometimes called a vaginal vault smear. Your GP or gynaecologist can organise this for you, as vault smears aren’t done as part of the NHS Cervical Screening Programme.