Loop electrosurgical excision procedure (LEEP)

A loop electrosurgical excision procedure (LEEP) uses a loop of thin wire that is heated by electricity to remove abnormal tissue from the cervix. The loop of wire acts like a scalpel to remove the tissue. LEEP may also be called a loop excision or large loop excision of the transformation zone (LLETZ).

LEEP is one way of doing a cone biopsy.

Why LEEP is done

LEEP may be done to:

  • try to find out what is causing an abnormal Pap test result
  • diagnose precancerous changes of the cervix and cervical cancer
  • treat precancerous conditions of the cervix and carcinoma in situ in the cervix

How LEEP is done

LEEP usually takes only a few minutes, and you don’t need to prepare in any particular way. It may be done in your doctor’s office, at a colposcopy clinic or at a hospital.

During LEEP, you will be in the same position as you are for a Pap test – lying on your back with your feet up in stirrups. The doctor will place a speculum (the same instrument used during a Pap test) into the vagina to keep it open. Local freezing will be used to numb your cervix and you may be given pain medicine by mouth or IV (intravenous).

The doctor uses a colposcope (a lighted magnifying instrument) to look at the vagina and cervix and to guide the loop of wire to the tissue in the cervix. The wire loop uses heat to remove the abnormal cervical tissue. During a LEEP you may hear some noise coming from the equipment connected to the wire loop.

An endocervical curettage may be done at the same time as LEEP. This procedure uses a brush or a tool called a curette to remove cells from the endocervical canal (the passageway from the uterus to the vagina).

The cervical tissue and cell samples are then sent to a lab to be looked at under a microscope.

After LEEP, most women are able to return to most of their normal activities within 1 to 3 days. You will be told to avoid sexual intercourse, douching and using tampons for 3 to 4 weeks.

Every 4 to 6 months, you will have a Pap test. After your Pap test results have been normal for a few times, you and your doctor will decide how often you should have the test. There is a small risk that LEEP will need to be repeated if there is still disease after the first procedure.

Side effects

Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way.

Common side effects may include:

  • menstrual-like cramps
  • dark brown discharge from the vagina during the first week
  • spotting (small amounts of blood) or discharge from the vagina during the next 3 weeks

Less common but more serious side effects include:

  • heavy bleeding from the vagina
  • pain that doesn’t go away with pain medicine
  • signs of infection such as increasing pain, fever and discharge from the vagina that is yellowish and smells bad

Most women have no problems after having LEEP. Problems that can occur include:

  • delivering the baby early if you get pregnant after
  • having painful periods and trouble getting pregnant (caused by narrowing or scarring of the cervix)

What the results mean

A pathologist will examine the tissue removed during LEEP under a microscope. The pathologist’s report will tell your doctor if the cells of the cervix are normal, precancerous or cancerous.

What happens if the results are abnormal

Your doctor may recommend more tests, procedures, follow-up care or treatment.

Expert review and references

  • Loop electrosurgical excision procedure (LEEP) for abnormal cervical cell changes. British Columbia Ministry of Health. HealthLink BC. 2017: https://www.healthlinkbc.ca/health-topics/hw28185#show-all.
  • Fischbach FT, Fischbach MA. Fischbach's A Manual of Laboratory and Diagnostic Tests. 10th ed. Wolters Kluwer; 2018.
  • Klopp AH, Eifel PJ, Berek JS, Konstantinopoulos PA . Cancer of the cervix, vagina and vulva. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 72:1013-1047.
  • Kunos CA, Abdul-Karim FW, Dizon DS, Debernardo R . Cervix uteri. Chi DS, Dizon DS, Berchuck A, and Yashar C (eds.). Principles and Practice of Gynecologic Oncology. 7th ed. Philadelphia: 2017: 20: 467 - 510.
  • Levine DA, Dizon DS, Yashar CM, Barakat RR, Berchuch A, Markman M, Randall ME. Handbook for Principles and Practice of Gynecologic Oncology. 2nd ed. Philadelphia, PA: Wolters Kluwer; 2015.