LLETZ Treatment NHS – what happens?

I wrote a blog post in 2019 about my first Colposcopy appointment, which you can read about here.

That visit identified low-grade CIN1 cell changes to my cervix as a result of the all-too-common HPV virus. You can learn all about HPV here. In most cases, the HPV and abnormal cells go away on their own before you even know about them, and I was naively hoping this might be the case for me. More than a year later, I had a follow-up smear and got a nice fat letter in the post. A fat letter means there’s a booklet included, and we all know that means an appointment. I was miffed, but I wasn’t upset – more grateful to be monitored properly rather than fall through the net and end up in a worse situation. All right, they detected abnormalities – but imagine if they’d never detected them and they were left to grow and develop on their own? It doesn’t bear thinking about.

So, there I was, back in the chair at my second colposcopy appointment. This went smoothly like before and, like before, they took biopsy. A biopsy is clipped from your cervix with a long instrument but, honestly, I didn’t feel a thing – please don’t sweat this if you’re waiting for your appointment. The consultant said she thought it was still CIN1, and that we could possibly wait another six months – however, by that point it would be 2 years with HPV and abnormal cells. By that point, it’s unlikely they’ll clear up themselves, and I would be facing the LLETZ procedure.

I knew about the LLETZ procedure because my own mother had one sprung on her many years before. I remember sitting in the waiting room for what felt like an age to my teenage self, and out came mum looking shell-shocked. They’d found abnormal cells and offered treatment there and then, which she agreed to. Unfortunately, she had a “learner” do the procedure and they failed to give mum the correct amount of anaesthetic. Mum initially felt the procedure happening and squeezed the nurse’s hand – it’s only when the nurse noticed her expression that she asked in a startled voice, “Are you able to feel this?!”

My mum’s case is thankfully a rarity, but it did give me cause for concern. Regardless of any worries in the back of my mind, I was at least always prepared to one day go through the same thing and, in the face of all the many other procedures I’ve had, this one wasn’t much worse. I find the intimacy is what makes it so much more uncomfortable for women to face; you’re talking about the entrance to our wombs, the most sacred parts of us.

Anyway, my latest biopsy results returned with CIN2, not CIN1, and I wasn’t happy about that. Seeing the abnormal cells progress told me everything I needed to know, and I called up the clinic to ask if I could volunteer to have the procedure. The nurse couldn’t have been kinder and was happy to hear a patient being proactive about their health – she booked me in on the spot. I ended the call feeling positive that I’d taken my health into my own hands. Incidentally, when they discussed me at their MDT meeting, they decided I should have the LLETZ as well.

So, today was the day – I was finally having the LLETZ procedure! Frankly I was excited – my partner and I are planning a family and this was another hurdle in the way of what will already be a process of proper planning. Because of my blood pressure issues, I will need extra monitoring and a change of medications, and so preparing for a baby will be very much a team effort!

I was commended by my nurse and consultant who seemed surprised to have a patient so calm – again, I put this down to my many experiences and procedures in hospital, being a seasoned patient by now. Hospital for me is a place of sanctuary, and not at all a place to be feared. The LLETZ went very much the same way as the Colposcopy – bottoms off, legs up in the stirrups, bum to the edge of your seat. Speculum in, cold jelly on the labia, a bit of a push. Crank her open and let’s have a look-see.

Next comes an local anaesthetic, but please believe me when I tell you: I barely felt it. It is not sharp and it doesn’t hurt. Ask anyone else who’s had the LLETZ and you’ll find most say the same – they feared it, but it was not actually bad at all. My heart-rate went up moments later and I felt a bit wobbly – I was told this was totally normal, because the local anaesthetic involves a bit of adrenaline. We chatted a few moments while we waited for it to kick-in. Once it had, the consultant told me the machine would be a bit noisy – like a vacuum cleaner – and asked that I tell her if I’m uncomfortable. She specifically asked several times not to jump suddenly or flinch – a big ask for some, I’m sure – which gave me some insight into what some of their patients’ responses must be. She told me some appointments aren’t so quick as mine because patients are sometimes very nervous or find the whole procedure very difficult, which naturally adds another element to the process.

Reader, she fired up the machine once or twice, cleaning in-between, and it was over. I could smell the burning once or twice, but I felt nothing except the odd bit of pressure during the procedure itself. It was over so quickly that I was back in my undies and leggings in a matter of minutes, looking at my sample in its little red pot. The consultant took a small section from directly around the opening of the cervix, about as big as a five pence piece (or perhaps 10 pence, I forget). This will go off for biopsy once more, and I will have a smear test in 6 months to check for HPV or abnormal cells again. However, the consultant assured me she’d got the lot, so I was content. She advised me that I would need to let my midwife know in the future that I’ve had the LLETZ procedure so they could monitor the health of my cervix properly, as there is a small chance of pre-term labour after LLETZ. Again, I was assured the data suggested this could be coincidental and didn’t necessarily cause pre-term labour; but, being a risk, they have to let me know.

If you’re going for your LLETZ procedure, know this: it is all in the mind. Try to relax as best you can and believe me when I tell you that the local anaesthetic is a little miracle, and you shouldn’t feel much at all, if anything. What’s more important is that YOU are taking steps to better your health and keep yourself safe, and that’s a brave and brilliant thing.

I felt a lot of pride walking out of the clinic – a ward run by women, for women, for the sake of women’s health. We’re united in these experiences, and short of saying “girl power!” I can hardly express how awesome it feels to be among my own sex.

The night before the procedure, I wrote this poem. It seems daft now, but these were very real thoughts at the time, and I think a lot of women in the same boat as me could relate to this.

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