Colposcope in a medical examination room

LLETZ and Cone Biopsy

Overview

LLETZ (Large Loop Excision of the Transformation Zone) and cone biopsy are procedures used to diagnose and treat abnormal changes of the cervix, typically following an abnormal cervical screening (smear) result. These changes are known as cervical intraepithelial neoplasia (CIN) and are most often caused by persistent infection with high-risk types of human papillomavirus (HPV).

These procedures involve removing a small section of the cervix containing the abnormal cells, which is then sent for laboratory analysis. The aim is to both confirm the diagnosis and to treat the condition by removing all affected tissue.

Indications

  • High-grade CIN (CIN2 or CIN3)
  • AIS (adenocarcinoma in situ)
  • Discordant cytology and colposcopy
  • Histological confirmation of cervical abnormalities
  • In some cases, as treatment for early stage cervical cancer

What to Expect

Both LLETZ and cone biopsy are typically performed under local anaesthetic in an outpatient clinic or under general anaesthetic in theatre, depending on the extent of the lesion and patient preference.

A wire loop heated by electric current is used in LLETZ, while a cone biopsy removes a deeper, cone-shaped piece of tissue and is usually done in theatre.

After the procedure, you may experience:

  • Mild to moderate cramping
  • Watery or blood-stained discharge for 1–4 weeks
  • Temporary avoidance of tampons, swimming, baths, and intercourse (usually for 4 weeks)
Surgical adhesions
LLETZ (Large Loop Excision of the Transformation Zone) is the most common procedure to remove precancerous cells from the cervix. A thin wire loop heated by an electrical current is used to precisely cut away the abnormal tissue, which is then sent to a lab. This simple, quick outpatient procedure effectively prevents these cell changes from developing into cervical cancer.

Recovery and Risks

Most people recover within a few days. Rest and avoiding strenuous activity for the first few days are advised. Risks include:

  • Bleeding
  • Infection
  • Cervical stenosis
  • Rarely, cervical insufficiency in future pregnancies (more commonly with cone biopsy)
Dr Sam Holford

Abnormal smear?

LLETZ or a cone biopsy are simple procedures to remove abnormal cervical cells. As an Auckland specialist, I perform this common treatment to prevent cervical cancer.

Book an appointment

FAQs

Is a LLETZ procedure painful?
A LLETZ is usually performed with local anaesthetic injected into the cervix to numb the area, so you should not feel any sharp pain. You might feel a dull ache, similar to period cramping, and a sensation of pressure. The procedure is very quick, usually lasting only a few minutes.
Will this procedure affect my ability to have children in the future?
For most people, a single LLETZ procedure does not have a significant impact on fertility or future pregnancies. A cone biopsy, which removes more tissue, or having multiple procedures, can slightly increase the risk of premature birth in the future. We will discuss your individual circumstances and future plans.
How long is the recovery after a LLETZ or cone biopsy?
Recovery is generally fast. Most people feel well enough to return to normal activities the next day. It is normal to have a watery, sometimes blood-stained discharge for up to four weeks. You will be advised to avoid tampons, swimming, and sexual intercourse during this time to allow the cervix to heal.
Do I need to do anything differently after the procedure?
The main thing is to allow your cervix to heal. For about four weeks, you should avoid putting anything in the vagina, including tampons and sex toys, and avoid heavy lifting. This helps prevent infection and bleeding.
Will the abnormal cells come back?
A LLETZ or cone biopsy is successful in removing the abnormal cells in over 90% of cases. There is a small chance that the changes could recur, which is why it is very important to attend your follow-up cervical screening tests as recommended.

Resources

Why Choose Me?

I am C-Quip certified in colposcopy and cervical dysplasia management, with extensive experience managing abnormal cervical screening results, including those with glandular changes and complex presentations. My approach is evidence- and national guideline-based, patient-centred, and always includes clear discussion of your options and what to expect before, during, and after any procedure.

Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.