Loop excision treatment Gynaecology Outpatient Department

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1 Information for women This leaflet can be made available in other formats including large print, CD and Braille and in languages other than English, upon request. You have been referred for a colposcopy appointment because your cervical sample (smear test) has identified that you have some abnormal cells on the cervix (neck of the womb). These abnormal changes are called Cervical Intra-epithelial Neoplasia (CIN). Having these cells treated will help to stop them developing into cancer. When you come to the colposcopy clinic a colposcopist (a doctor or nurse who is trained to examine the cervix) will examine your cervix. If your cervix shows abnormal cells you will be offered treatment. It is unlikely you will have cancer. Treatment is not always needed during your first visit and if this is the case a biopsy (a small sample of tissue) will be taken to confirm the type of abnormal cells present. What treatment will I receive? The treatment is called LETZ (Loop Excision of Transformation Zone). This treatment removes the abnormal area of your cervix. It is usually carried under a local anaesthetic (a drug injected into your cervix to numb the area so you do not feel any pain) in the clinic. Gynae/548 (2016) Page 1 of 7 For Review Winter 2019

2 A pen with a small heated fine wire loop is used to remove the abnormal cells on your cervix (see below). You should allow about 1 hour for the whole visit. The preparation for the treatment usually takes 20 minutes. The treatment usually takes 2-3 minutes. 95 women in every 100 usually only need 1 treatment with only a small number of women needing further treatment. 1 There will be a screen where you can watch the examination and treatment if you wish. Sometimes the colposcopist may ask your permission to take some pictures for medical records and teaching purposes. Your sample(s) or tissue may be stored to allow us to check your test results again, if needed, at a later date. Sometimes samples taken may be used for teaching, research or public health monitoring in the future interests of all NHS patients. Samples kept for this purpose will not identify you. You have the right to refuse consent for samples of your tissue to be used for teaching or research purposes. If you refuse consent; this will not affect your treatment in any way. What happens when I come for treatment? To prepare for the treatment you may find taking simple painkillers such as Ibuprofen or Paracetamol tablets about 1 hour before your appointment may help. You should always follow the instructions provided in the leaflet supplied with your tablets You are welcome to bring a relative or friend if you wish. Before the colposcopy examination you will be asked to undress from the waist downwards in a private room. You will be provided with a hospital gown but you may wish to wear a loose skirt or dress so that you do not have to remove all your lower clothing. Gynae/548 (2016) Page 2 of 7 For Review Winter 2019

3 The nurse will help you to position yourself on the examination couch and will make sure you are comfortable throughout the procedure. The colposcopist will put a speculum inside your vagina (just like when you had the smear) and will place some solution onto your cervix to help identify the abnormal cells. The colposcopist will then give you a local anaesthetic directly into your cervix which numbs the area before the treatment starts. The treatment is usually painless but you may sometimes experience some discomfort. The machine used for the treatment is noisy. This is normal so do not be alarmed. What are the risks and possible complications? The risks are very small and will be discussed in more detail when you come to clinic. They are listed below: Bleeding. Infection. Cervical Stenosis. This means that the opening in the cervix is more narrow than normal. In some cases it may be completely closed. If this happens further treatment may be needed. Problems with future pregnancies. A single treatment is not linked with any increase in the incidence of preterm labour (labour between weeks gestation) or infertility but may increase the risk of miscarriage. 1 The doctor or nurse will discuss this with you further in your appointment pre treatment if you are of child bearing age. How will I feel when I go home? You may have some discomfort for 1-2 days after this procedure. Taking painkillers, for example, Paracetamol or Ibuprofen can help. Always follow the instructions provided in the leaflet supplied with your tablets. After your procedure you may also have mild bleeding and a watery brown discharge from your vagina for up to 4 weeks. If: you have any heavy bleeding you have any discharge with an unpleasant smell from your vagina you feel feverish, unwell or develop a high temperature your pain increases You should contact your GP or the Outpatient Department where you had your procedure for further advice. (See contact numbers.) Gynae/548 (2016) Page 3 of 7 For Review Winter 2019

4 If the bleeding becomes heavier following your LETZ treatment you must contact your GP or the Outpatient Department where you had your procedure for further advice. If you cannot contact your GP or the Outpatient Department is closed, you should contact the Accident and Emergency Department at your local hospital for advice. (See contact numbers.) What can I do to help myself? You should not have sexual intercourse or use tampons for the next 4 weeks to give your cervix time to heal. For the first 2 weeks, you should avoid: alcohol very hot baths strenuous physical activity or heavy lifting swimming until the discharge or bleeding stops. When can I return to my normal activities and work? You may drive and return to work after your treatment unless advised not to by your doctor or nurse in the clinic. You may also experience a temporary change in your menstrual pattern after treatment. Your next period might be heavier than normal but this will return to normal. Although there are no known health grounds for avoiding travel following treatment, overseas medical attention for complications arising from treatment may not be covered by insurance. Will I need to return to hospital? Your nurse will tell you if you need to be seen again in the Outpatient Department and if so will either: or ask you to make another appointment before you go home arrange for an appointment to be sent to you through the post. If you have any worries please contact the Outpatient Department Gynae/548 (2016) Page 4 of 7 For Review Winter 2019

5 When will I be told the results of my biopsy? Your biopsy will be sent to the laboratory for testing. It can take 4 6 weeks to get the results of these tests. Your nurse will tell you how you will receive your results. This will be either: or in a letter sent to you through the post Discussed with you during your next outpatient appointment. Your GP will also be sent a letter explaining the results of your biopsy. Do I need follow-up? You will need to have a smear test (with HPV testing) in 6 months time at your GP surgery unless advised otherwise by your colposcopist. You will receive a reminder in the post. It is very important you go for your cervical sample to ensure the treatment has worked. Contact numbers If you need further advice or have any problems, please telephone the Outpatient Department at the hospital where you had your biopsy: University Hospital of North Tees Outpatient Department telephone: Monday Friday, 9.00am 5.00pm Accident and Emergency Department telephone: hours a day, 7 days a week University Hospital of Hartlepool Outpatient Department telephone: Monday Friday, 9.00am 5.00pm Gynae/548 (2016) Page 5 of 7 For Review Winter 2019

6 If you have any worries or concerns you should contact your GP during normal surgery hours. Outside surgery hours, you should contact your GP s surgery for the Out of Hours Service number. Further information is available from: NHS Choices telephone: 111 (when it is less urgent than 999) Calls to this number are free from landlines and mobile phones or via the website at Reference 1. BSCCP,Document20,March 2016) Gynae/548 (2016) Page 6 of 7 For Review Winter 2019

7 This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Quality Assurance Team, University Hospital of North Tees or Comments, Concerns, Compliments or Complaints We are continually trying to improve the services we provide. We want to know what we re doing well or if there s anything which we can improve, that s why the Patient Experience Team is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. If you would like to contact or request a copy of our PET leaflet, please contact: telephone: Monday Friday, 9.00 am 4.00 pm Messages can be left on the answering machine and will be picked up throughout the day. freephone: Mobile: (can use text): patientexperience@nth.nhs.uk Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person. telephone: hours a day, 7 days a week The Patient Experience Team is available to discuss your concerns in person Monday Friday, 1.30 pm 4.30 pm. The office is based on the ground floor at the University Hospital of North Tees. Data Protection and use of patient information The Trust has developed a Data Protection Policy in accordance with the Data Protection Act 1988 and the Freedom of Information Act All of our staff respect this policy and confidentiality is adhered to at all times. If you require further information please contact the Information Governance Team. telephone: or information.governance@nth.nhs.uk University Hospital of North Tees, Hardwick, Stockton-on-Tees. TS19 8PE University Hospital of Hartlepool, Holdforth Road, Hartlepool. TS24 9AH Telephone: Fax: Gynae/548 (2016) Page 7 of 7 For Review Winter 2019