The Pros and Cons of LEEP

"Abnormal Pap smear" are three words you don't want to hear when getting your Pap results. If you do get that result, the likely follow-up is a colposcopy, a procedure that closely examines your cervix. Then, if there's still some concern, you may be advised to get a LEEP procedure. 

"If your doctor finds precancerous cell changes in your cervical tissue, also known as cervical dysplasia, the area around the tissue may need to be surgically removed to reduce the risk and spread of cancer," said Thais Aliabadi, M.D., a board-certified OB-GYN and founder of Trimly, a medical weight-loss practice based in Los Angeles.

While LEEP can sound like a no-brainer, some patients experience side effects. Here's an in-depth look at the pros, cons and what you can expect from a LEEP procedure.

A LEEP is a relatively quick procedure that can be done with local anesthesia and usually causes less scarring and removes less tissue from the cervix than other methods. Side effects include discomfort and bleeding that typically resolves itself. There is a risk of infection similar to what you'd experience from any other procedure. In some cases, LEEP can cause cervical scarring and can lead to a higher risk of having a preterm baby, explained Christine Greves, M.D., an OB-GYN at Orlando Health Winnie Palmer Hospital for Women & Babies in Florida.

"The LEEP has more pros than cons," Aliabadi said. "If you are getting rid of precancerous cells on the cervix and treating HPV [human papillomavirus], you are also preventing yourself from getting cervical cancer. Cons include pain, discharge and discomfort during the procedure. And you'll need to have more frequent Pap smears to ensure there are no more abnormal cells."

"There was some bleeding for a few days afterward, and I had to wear pads for the first time in probably 15 years. But otherwise, it was fine," said Elisa, 33, who had a LEEP procedure done by Ruth Cousineau, M.D., and nurse practitioner Rachel Murray at Women's Care of Beverly Hills in California.

"For me, the pros were that my LEEP led to me having no HPV or cervical cancer, which is a really big deal," Elisa added. "As for the cons, I think there may be a very slight risk of pregnancy complications, but as my OB-GYN and nurse practitioner explained, the risks are very low, especially compared to the benefits of not having cervical cancer."

Jennifer, 34, underwent a LEEP about 10 years ago in the United Kingdom and has had no issues since the procedure.

"The worst part was the bleeding; that was fairly heavy and did last three weeks or so," she said. "A couple of times, some scar tissue—looked like a scab—came out, which freaked me out, but again, wasn't painful. I was 23 at the time, so using pads for a prolonged period was inconvenient but, obviously, something I just got on with."

The LEEP procedure also has pros and cons where pregnancy is concerned.

"The LEEP is considerably safe," Aliabadi said. "All risks need to be discussed with your doctor, but can include cervical stenosis, cervical scarring, tissue damage, hemorrhage and infection. LEEP can rarely cause an 'incompetent cervix,' which may result in a premature delivery. You and your doctor will be able [to] discuss the risks and benefits to see if this is the right procedure for you."

Cervical stenosis and scarring may impact your chances of pregnancy later on, and can also affect your pregnancy.

"Cervical stenosis is a complication that arises when the cervix becomes narrow, in turn making it a bit more difficult to become pregnant naturally. Some women experience problems with fertility due to cervical scarring," Aliabadi said.

There also is a small increased risk of giving birth before the due date, but a LEEP does not cause this occurrence; it is simply associated with a greater risk. If you are trying to conceive, the procedure can delay your attempts because you cannot have sex for four to six weeks after the procedure, Greves added.

"I have one child and another one due any day now," Jennifer said. "I did receive an ultrasound during both pregnancies to ensure my cervix was long enough to sustain a pregnancy successfully and, thankfully, there were no issues found."

During the loop electrosurgical excision procedure (LEEP), your cervix is numbed.

"This procedure is referred to as a cervical block and it may be combined with oral or intravenous pain medication. Additionally, in order to significantly reduce both pain and anxiety during this treatment, I sometimes use nitrous oxide, also known as 'laughing gas,'" Aliabadi explained.

"The worst part of the actual procedure I remember was the local anesthetic being injected into the cervix. I found that to be so painful," Jennifer recalled. "But I genuinely didn't feel a thing after that and was able to return to work the next day with little to no pain…I believe some women think it sounds very invasive, which was not my experience at all. It was, for me, quick and relatively pain-free. I would hope this to be the same for most women."

"I don't remember much of the procedure itself," Elisa said. "In what felt like no time at all, they told me it was over."

For my own LEEP, I regret not getting anesthesia. The procedure was more uncomfortable than painful, mostly from having a speculum inside me longer than I'm used to from my annual Pap smear. The worst part was the sound of the heated wire loop removing precancerous cells, which was similar to a drilling noise. After the procedure, I felt mild cramping for about 24 hours, but other than that, the pain was not bad.

If you have to get a LEEP it does not mean you have cervical cancer, Greves pointed out. In fact, the whole point of a LEEP is to decrease your chances of cervical cancer.

"The LEEP instrument is a narrow wand with an electrified wire loop at the end. The loop passes through the cervical tissue and removes a sample. We want to remove the abnormal cells to decrease the patient's chances of cancer," Aliabadi explained.

Both Jennifer and Elisa have had clear Pap smears and tested negative for HPV since their LEEPs.

It takes about two to three weeks to fully recover. Don't perform any heavy lifting or excessive workouts.

"A patient may experience some mild cramps that can be managed with ibuprofen or a heating pad, vaginal discharge for one to three weeks after the procedure, bleeding, and discharge that's dark red to brown in color," Aliabadi said.

After three to four months, you need to check in with another Pap test to monitor your cervical cells and ensure your cervix is healthy.