If your health care provider has said you need a loop electrosurgical excision procedure, or LEEP, you may be wondering exactly what a LEEP is. A LEEP is a preventive treatment in which a doctor uses a heated wire loop to remove abnormal cells from the cervix before cancer develops.
“A LEEP is a really important procedure because it prevents cervical cancer,” says gynecologic oncologist Kathleen Schmeler, M.D.
The abnormal cells found in the cervix are typically caused by the human papillomavirus (HPV), but the LEEP can eliminate the effects of an HPV infection.
We spoke with Schmeler about who needs a LEEP and what you can expect during one.
Who needs a LEEP?
After abnormal cells are found in a Pap test, a gynecologist will perform a colposcopy. During this procedure, a doctor closely examines your cervix with a special instrument called a colposcope and performs biopsies of the cervix. If the results show that a patient has precancerous cells (high-grade dysplasia), then a LEEP is recommended.
“If a doctor suggests you need a hysterectomy for abnormal cervical cells before getting a LEEP, it’s a great time to get a second opinion,” Schmeler says, noting that a LEEP can prevent the need for a hysterectomy in some cases. “Even if your doctor has said you need a LEEP, I recommend getting a second opinion. We want to catch cancer before it develops, but we also don’t want to do any procedure unnecessarily.”
What should patients expect when preparing for a LEEP?
At MD Anderson and many other hospitals, a LEEP is an outpatient procedure performed in a clinic. Years ago, it was performed in an operating room, and some hospitals still perform them there.
During a LEEP, the clinician numbs the cervix with a local anesthetic. Then, the clinician removes the abnormal cells using a heated wire. The procedure takes about 10 to 15 minutes, and the patient should expect the entire visit to last no longer than an hour.
Does a LEEP hurt?
Patients may feel some discomfort when the local anesthetic is applied. Afterward, they shouldn’t experience any pain, although they may feel some pressure.
“It’s in line with a simple procedure at the dentist,” Schmeler says.
How long does it take to recover from a LEEP?
Patients can return to work one to two days following a LEEP, and can return to exercise soon after, depending on instructions from their care team. Patients are advised to refrain from having sex or using tampons for four weeks after the procedure so they can fully heal.
Following a LEEP, patients may experience some discomfort, cramping or bleeding, similar to a period.
What are the risks associated with a LEEP?
In very rare instances. patients have experienced bleeding or infection.
Can a LEEP impact fertility or pregnancy?
A LEEP isn’t likely to impact your fertility.
“There is a small risk of future pregnancy loss or pre-term birth associated with a LEEP,” Schmeler says. “But a vast majority of women who have LEEPs go on to have healthy pregnancies and healthy babies.”
If you’re concerned about your fertility, share your fears and your future plans with your care team so they can address them and choose the treatment that’s best for you.
How will a patient know if a LEEP was effective?
The tissue removed during the LEEP is sent to a pathologist for review. If the margins are positive, you may need a repeat procedure. In addition, six months following a LEEP, you’ll have a follow-up appointment that includes Pap and HPV tests. In some cases, abnormal cells are found again. If this happens, you may require another LEEP.
Following a normal Pap and negative HPV test, patients are required to come back a year later for another screening. Women with high-grade dysplasia who undergo a LEEP need to be followed closely for 25 years to make sure it does not recur.
How common are LEEPs?
Although cervical cancer is rare, precancerous lesions are relatively common. Approximately 10% of women undergoing cervical screening will have an abnormal Pap and/or positive HPV test result, but less than 1% will have cancer. However, 3% to 5% will have precancerous cells (high-grade cervical dysplasia) and need a LEEP.
“At MD Anderson we perform about 75 to 100 LEEPs a year, and our team performs an additional 150 to 200 a year through the MD Anderson Oncology Program at Lyndon B. Johnson Hospital,” Schmeler says.
This year, Schmeler has seen a decrease in overall LEEPs performed. It’s not due to a decrease in HPV cases or in the occurrence of abnormal cells, though.
“We’ve missed the opportunity to perform LEEPS because people haven’t been getting their check-ups during the COVID-19 pandemic,” she says. “If we aren’t doing LEEPs, I worry we’ll see an increase in cervical cancer cases in the coming years. Patients who have putting off their routine screenings should schedule them right away.”
Schmeler also recommends that those eligible get the HPV vaccine, which can prevent the development of cervical cancer and abnormal cells and therefore the need for a LEEP. The HPV vaccine is given in two doses for males and females ages 9-14. Beginning at age 15 through age 45, three doses are required for full immunity.
“The LEEP is a great tool for cancer prevention. Getting a LEEP is a good thing,” Schmeler says. “But not needing a LEEP because the HPV vaccine prevented the growth of abnormal cells is even better. I hope that one day all women have access to HPV vaccination, cervical screening and, if needed, a LEEP so that cervical cancer can be eliminated.”