Loop electrosurgical excision procedure (LEEP)

A loop electrosurgical excision procedure, or LEEP, helps with the diagnosis and treatment of abnormal cells or cancer found in the cervix.

What is a LEEP (loop electrosurgical excision procedure)?

LEEP is a procedure in which the care team uses a thin wire loop that’s heated by an electric current to remove abnormal tissue. The wire loop comes in different sizes and acts as a surgical knife, cutting away at the abnormal tissue. The tissue is then sent to a laboratory for further analysis.

Why do I need a LEEP?

There are a few reasons the doctor may recommend a LEEP:

• To diagnose precancerous changes in the cervix and cervical cancer (precancer refers to abnormal cells that could become cancer)
• To figure out the cause of an abnormal Pap test result
• To treat precancerous conditions and early-stage cancer in the cervix

How to prepare for a LEEP

There are a few things women can do ahead of a LEEP appointment:

• Make sure to schedule the LEEP when menstruation isn't likely to happen.
• The patient should tell the cancer care team about all of her current medications, as well as any herbal supplements. Patients who use blood-thinning medicines, aspirin or other drugs that affect blood clotting may be asked to stop them temporarily before the procedure.
• Patients should let the care team know if they are or might be pregnant.
• Don’t use douches, tampons or vaginal creams before the procedure. The care team will indicate how far in advance to stop these.
• Don’t have vaginal sex before the procedure.
• Ask whether it's a good idea to take pain-relieving medication beforehand. Follow any instructions on which type of medication to use.
• Consider taking a sanitary napkin to wear home when the LEEP is done. Women may experience some bleeding or discharge.

What to expect from a LEEP (loop electrosurgical excision procedure)

The LEEP is usually performed in the doctor’s office, though at times, some providers may choose or prefer to perform it in the operating room. The procedure lasts a few minutes.

Before the procedure, the patient will remove all clothes from the waist down and empty her bladder. She will then lie down with her legs in stirrups, similar to what occurs during a pelvic examination. The doctor places a speculum in the vagina to open the vaginal canal.

• The doctor typically administers local anesthesia intravenously. This type of anesthesia is used to numb just the cervical area.
• Many doctors use a colposcope, which is an instrument with a special lens, to better visualize the tissues. This device is placed at the vaginal opening, but it doesn’t go inside the patient's vagina. The doctor may take photos using the colposcope for the patient's health records.
• The doctor may place a special vinegar solution on the cervix to make any abnormal tissues easier to see. Then, the loop is inserted through the vagina and to the cervix. The loop can remove abnormal tissue and take a tissue sample for analysis.
• Once finished, the patient may have a paste-like medicine, called Monsel's paste, applied to her cervix to help control bleeding.

During the LEEP, the patient may feel some dull cramping. It’s also possible that she may feel as if she's going to faint. If this happens, alert the doctor.

LEEP procedure recovery

Most women can resume their normal activities after one to three days. However, the doctor may advise the patient to not have sex, take baths, douche or use tampons for about two to four weeks after the LEEP. The patient may also need to avoid strenuous activities and heavy lifting for a period of time.

Most women find that the timing of their menstrual period isn't interrupted following the LEEP procedure.

Side effects of LEEP

The benefit of the LEEP is that it can help remove precancer or early-stage cancers from the patient's cervix or vagina.

There are some LEEP-related side effects, including:

• Cramping similar to that during menstruation
• Dark brown discharge in the first week. This is from the solution that may be used on the cervix
• Small amounts of blood from the vagina in the following three weeks

The LEEP also may cause more serious side effects, though these aren’t as common. They include:

• Fever, intensifying pain and discharge from the vagina that has a bad smell (these may indicate a possible infection)
• Heavy bleeding
• Pain that doesn’t subside with medicine

Let the doctor know right away if any of these more serious side effects occur.

Long-term side effects of LEEP

A small number of women may have trouble getting pregnant after undergoing the LEEP. Rarely, though, it is also possible to experience changes to menses, like having more painful periods.

In addition, women who underwent a LEEP procedure in the past may deliver a baby earlier if they get pregnant. This is particularly true of women who have a large amount of tissue removed or who undergo more than one LEEP procedure, since these factors can weaken the cervix.

Reviewing the results of a LEEP

The doctor sends any tissue samples to a pathologist, who can study them under a microscope. The pathologist writes a report stating whether the tissue samples are normal or indicate precancer or cancer. Discuss any questions with the care team.

Depending on the results, the patient may need to have additional tests or treatments to make sure all abnormal tissue was removed or doesn’t recur. The doctor may ask the patient to return for more frequent Pap tests after having a LEEP.