How Soon After a LEEP Procedure Can I Get Pregnant?
About 13,000 new cases of cervical cancer are diagnosed annually, while 4,000 women succumb to the disease each year, according to the Centers for Disease Control and Prevention (CDC). The people most at risk are Hispanic and Black women.
Anyone with a cervix could potentially develop cervical cancer. However, the average age at diagnosis is 50, and it's more likely to occur in people who have human papillomavirus (HPV).
A loop electrosurgical excision procedure (LEEP) is one common treatment method for HPV. But does LEEP affect fertility and pregnancy? Learn the details on LEEP below.
LEEP and your cervix
The cervix is a donut-shaped canal between the uterus and the vagina, and is a passage that allows fluids—such as sperm—to flow into the uterus while keeping bacteria out. This essential reproductive organ, when widened, allows a baby to pass through during childbirth. For the entire pregnancy—from conception until just before birth—the cervix holds and protects a baby inside the body. When the baby is ready to arrive, the cervix opens its gates.
The growth of abnormal cells on the cervix is due to HPV. Getting regular Pap tests, the annual procedures to detect abnormal cell changes in the cervix, is pivotal in diagnosing HPV and ultimately helping to prevent a future cancer diagnosis.
These cells are labeled as minor (low grade) or serious (high grade). Low-grade cells typically resolve on their own, whereas preventive treatments are strongly recommended for high-grade cells, also called precancerous cells.
LEEP can treat high-grade cervical dysplasia cells found on the cervix. While the procedure sounds like a mouthful, in short, a LEEP helps to prevent cervical cancer.
"It is often an office-based procedure where local anesthesia is injected into the cervix to numb the area,” said Sarah Yamaguchi, M.D., an OB-GYN in downtown Los Angeles. “Then a small wire device is used to cut—using cautery—a small area of your cervix out."
Doctors use a colposcope, a tool similar to a microscope, to zoom in on the cervix to search for abnormal cervical tissue. Your healthcare professional may use a vinegar solution (acetic acid solution) or an iodine solution to highlight irregular cells.
After the numbing agent is applied and the cervix is held open with a tenaculum, the LEEP wire passes through the tissues as required. The procedure takes little time, often under 30 minutes depending on the circumstance, said Alyssa Dweck, M.S., M.D., a gynecologist in New York.
Patients typically experience cramping and discharge after the procedure.
But if a LEEP removes part of the cervix, can this procedure impact pregnancy or childbirth?
Possible risks from LEEP during pregnancy
Without treatment, a person with high-grade cervical abnormalities has a 30 percent chance of developing cervical cancer, compared with the 0.7 percent figure for people who undergo treatment. Healthcare professionals follow national guidelines, which consider age and test results when determining treatment options.
"A LEEP can complicate future pregnancies if it is large and high into the cervix so that the cervix is weakened," Yamaguchi said. "However, most LEEPs are quite small and should not affect your future pregnancies."
Other uncommon complications can be cervical stenosis, or scarring of the cervix, which could lead to the cervix closing. It's a rare complication and is more likely to occur in people who have had more than one LEEP or heavy tissue removal.
Cervical stenosis can lead to infertility due to less fertile mucus, a blocked passage for sperm to travel through and reach the fallopian tube, and complications during in vitro fertilization (IVF).
"If it is not completely closed but there is scarring on the cervix, when you are in labor, sometimes that scar tissue needs to be massaged a little to break down the scar so that your labor can progress and your cervix can dilate," Yamaguchi said. "After a LEEP, you are at higher risk of cervical stenosis, but it is very rare if you are regularly menstruating."
Another potential complication is something called an incompetent cervix, which occurs when the organ becomes weakened and is unable to hold the pregnancy inside the uterus. This may lead to early dilation or miscarriage. Dweck said this typically occurs early in the second trimester.
"Thankfully, the integrity of the cervix after LEEP can be monitored by ultrasound during early pregnancy to assess integrity and a stitch called a cerclage can be placed to strengthen this integrity," Dweck said. "Noteworthy, LEEP can be done in a focal manner to minimize cervical incompetence risk."
Jessica A. Shepherd, M.D., said it was previously thought that LEEPs may interfere with future pregnancies.
"[However,] studies recently have shown that there is an increased risk of vaginal infections and premature rupture of membranes at term in consecutive pregnancy," Shepherd said. "However, it does not affect prematurity or miscarriage. Additionally, the benefit of the removal of additional endocervical tissue appears to be a protective factor against recurrence of abnormal cells."
In a 2014 study published in Obstetrics & Gynecology, researchers suggested preterm births—12 percent of U.S. babies are born preterm—typically occurred at about 37 weeks when the mother had a LEEP. The study suggested that women with a LEEP had the same risks as people with abnormal cells but not a LEEP. Therefore, abnormal cells may be to blame for preterm births rather than the procedure.
When can I have sex after LEEP?
Other complications of a LEEP include minor bleeding and infection.
"When addressed appropriately and in a timely manner, this should pose no significant risk to future pregnancy," Dweck said.
For sex after a LEEP, make sure you wait two weeks and take it easy in bed with plenty of rest. Every patient heals differently and may take more or less time to recover. Full recovery is approximately six months.
Shepherd said if you experience persistent issues, such as dysmenorrhea (cramping), amenorrhea (absence of periods), hematoma, pyometra (uterine infection), pelvic pain or infertility, it is important to tell your healthcare provider that a LEEP was done and to look at this as a possible cause.
As with other procedures, there could be complications. While pregnancy complications can be linked to a LEEP, other factors require consideration, such as the number of LEEP procedures and the severity of the condition. Speak with your doctor to learn more about LEEP treatment and whether it's the right choice for you.