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.

What Happens When You Have an Abnormal Smear Result

Welcome (or welcome back!) to my blog. I put up new posts every Wednesday.

Something happened recently which shook me up a little bit, and I thought it would be helpful if I passed on some of my own learning from the experience. You never know who you might be helping by sharing your thoughts, so here goes.

No sooner than I had shared on Facebook about the importance of attending your smear tests did I find my result in the mail.

It was a scary, abnormal result.

Even though I somehow *knew* I would get a bad result this time, it still hurt to have it confirmed right there in front of me, in black and white.

My letter – which repeatedly assured me this was not a diagnosis of cancer – told me I had borderline low-grade dyskaryosis (abnormal changes in the cells of my cervix) and the HPV virus, which can often contribute to these cells lingering.

You can learn more about the cell-grading system here, and about HPV here.

These cells may or may not be pre-cancerous, and over time – if left untreated – may grow into cancer cells over a roughly 10 year period.

Low-grade cells with HPV, however, can usually go away on their own.

The letter said an appointment for a Colposcopy, which is a more in-depth look at the cervix, would be forthcoming.

How I reacted

I’m ashamed to say that I instantly felt terror erupting through my body and I went off and cried about it. The fact is that while I know how I would reassure somebody else with the same letter (and even though I knew low-grade/borderline meant the lowest risk cell changes), I still could not reassure myself.

This is because I have had an enormous lot of grief concerning my health in the last 2 years – some of which I’m willing to talk about, and some I’m not ready to. I plan to blog about these subjects in the future in the hope that somebody else can benefit from my experience. When you’ve already had an enormous amount of medical intervention, countless hospital stays, operations, and appointments resulting in nothing but bad news, you massively appreciate your freedom when you have it. You realise more than most just how much you have to lose.
I associated this letter about minor cell changes with those enormous fears, so naturally came the tears and the worry.

How I dealt with it

Firstly, I shared my disappointment and upset with those closest to me – I told my mum (who I blubbed to), my dad and brother, my boyfriend (who immediately became head researcher at Ashleigh Condon Towers and set about reassuring me), and my co-workers. A problem shared = less of a burden on you.

Secondly, I called the appointments line – my appointment was 26 November, which was over a month away at the time – and asked to go on their cancellations list.
This made me feel like I was being proactive and facing the problem head-on. There was no way I was going to wait a month, worrying myself sick, if I could help it.

By the following Monday, I received a call to say that an appointment had been cancelled, and could I come in at 2 O’clock? Yes, I could – and I brought my mum with me.

What happened at the appointment

I attended the Nightingale Women’s Clinic at Southend University Hospital.

I’ve been here a few times before for various reasons, and I’ve always felt well looked after. This time, I really needed that – and they did not disappoint.

Two extremely loving, down-to-earth, calming, reassuring, intelligent and professional female nurses explained what was going to happen and that they would gently take me through every step of the process as it occurred.

One of them said she’d even had the exact came procedure – and had the exact same low-grade cell changes and HPV virus – and I felt instantly more at ease.

I was asked to strip my bottom-half of any clothing (obviously) and sit in a wonky chair with my legs up in the stirrups. This is always great fun.

Next went in the speculum – again, always a hoot.

Then a camera on a robotic arm was placed in front of my opening – not inside it, or anywhere close to it actually – just between my legs.

The nurse offered to show me the wonders of my insides, but I declined – I’m usually fascinated by this stuff, but for some reason I just didn’t want to see my cervix. At this point, I was still too afraid of seeing something scary, such as a cancerous mass, however unlikely it was. In the end, I did end up seeing it anyway – it looked like a big pink blob with lots of pixels over it, as if someone was shopping it in Microsoft Paint (I’ll explain).

The nurse doing the procedure used a long instrument to swab my cervix, because I’d had a bit of blood spotting (typical) that day, and it was obscuring the view. I’ve described this feeling as someone tickling your guts with a feather – it’s very weird and slightly uncomfortable, but not painful.

After that, she explained that she was going to douse my cervix with a solution which would highlight areas of my cervix in red and green pixels on the monitor. She said this would sting slightly and have a vinegary smell. As well as her well-trained eyes, the camera would be looking for any abnormalities – double protection there.

The solution did indeed smell like vinegar and felt a bit strange, but no worse than a smear test or swab – we’re talking a quick splash here. Then we waited a moment while it developed (your cervix is essentially a Polaroid at this point).

As the solution got to work, it did indeed pick up pixels in red and green – and there were just a couple that were white. These were the cells with borderline changes.

The nurse told me she was very happy with that, and that they were agreeing with the result of the smear. These looked like low-grade, borderline cells which would hopefully go away on their own. I was so relieved.

However, she told me they usually still liked to take a biopsy just in case.

Gulp.

Of course, I agreed to it – but if I hadn’t been too uncomfortable before, I certainly was now. The nurse produced a long, scary Victorian-looking instrument with a clipper on the end – however, she didn’t look bothered and so I tried not to let it bother me either. I held the second nurse’s hand while she chatted to me about what I was going to have for lunch (key distraction techniques at play here!) and assured me I was going to be absolutely fine.

And I was.

The nurse with the instrument took the tiniest biopsy in about 0.2 seconds and I barely even felt its presence there, let alone any pain. It was no worse than your standard smear test and it didn’t hurt a bit. I promise you, if that wasn’t the case, I would be honest about it here – there was zero pain.

They told me I’d get my results in about 3 weeks, but they expected it to be a clear result. I left feeling warm, reassured, well looked-after, and confident that I had received amazing care.

Did you know that not all hospitals offer these in-depth checks on low-grade borderline changes to the cervix? I now feel very lucky indeed. I’ve been given the gold standard of treatment.

Before leaving, I promised them I would tell my family and friends about the experience and assure them that a Colposcopy and a cervical biopsy are nothing to be afraid of.

The key thing I took away was that these are preventative measures. If you keep up to date with your smears and take your health checks and examinations seriously, then you should never ever find yourself suddenly diagnosed with cervical cancer.

They will have found any problems well in advance, way before they could develop into something nasty – and they can deal with them. A brief check online will show you that removal of pre-cancerous cells usually results in a 100% cure of them – as in the cells are gone and, therefore, the risk of any cancer is gone. If cells return, they can remove them again.

Before leaving, I asked the nurses if – theoretically – someone already had cancer on their cervix, and they went for a routine smear test, would that test show up cervical cancer?

They said yes, it should.

This means that if you get a “scary letter” about abnormal cells, then remember: that is all they are. Abnormal cells, not a death sentence and definitely not cancer. You absolutely have control of this and you can ensure your health stays tip-top by attending the recommended appointment and having any treatment if necessary.

Whatever happens, you have got this, you’ve taken control of it, and you will be looked after by the professionals.

Aftercare

The advice for me was to not have sex for a day or so and to use condoms if you do. If you needed cell removal treatment, then obviously your cervix needs to heal, so follow the advice they give you.

I was told to expect a bit of tail-end period-style blood (which I have had) and maybe some gentle cramping (which I’ve not had).

Ultimately, what I do have is a feeling of control and relief that I could face this head on, and that I didn’t get any nasty surprises. I am beyond grateful to the staff for making an uncomfortable procedure so bearable – and honestly, it wasn’t even that bad at all.

If you need to attend a Colposcopy and if you need to have a biopsy, you have absolutely got this. Don’t run away from your smear tests or your follow-ups – you can do it. You will feel like a boss afterwards, I promise.

So there you have it. All’s well that ends well. I hope you found that useful and, if you have any questions, please don’t hesitate to ask me.

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