The treatment for CIN (cervical intra-epithelial neoplasia) partly depends on whether it is grade 1, 2 or 3. Often, cells showing CIN 1 will return to normal without any treatment at all. If your colposcopist decides not to treat these minor changes, further screening tests should be done (with the first repeat test after six months) to make sure that more cell changes do not take place. All doctors and researchers agree that CIN 2 and 3 should be treated.

The aim of treatments for CIN 2 and 3 is to remove the abnormal area or destroy the abnormal cells while causing as little damage as possible to surrounding healthy tissue.

Ways of removing the abnormal area include:

• large loop excision of the transformation zone (LLETZ)
• a cone biopsy
• (very rarely) a hysterectomy.

Ways of destroying the cells in the abnormal area (so that normal cells can grow back in their place) include:

• laser therapy
• cold coagulation
• cryotherapy.

Nowadays, LLETZ is the most common treatment method used.

Most women need only one of the treatments described on these pages. All of the treatments are usually very effective in removing the abnormal cells. The type of treatment you have will depend on a number of factors. These will include the facilities available at your local hospital and the type of treatment that your doctor feels is best for you.

Most women need only one session of treatment. LLETZ, laser therapy, cryotherapy, cold coagulation (and sometimes cone biopsies) are normally carried out in a hospital outpatient clinic, using a local anaesthetic. This means that you can go home after treatment. You may prefer for someone to either come with you while you are having the treatment or pick you up afterwards.

Before your treatment the nurse will help you to lie comfortably on the couch.  The doctor will then use a speculum to hold the vagina open.

Try to relax as much as possible and don't be afraid to ask the doctor or nurse as many questions as you like about your treatment. The treatment itself is likely to take about 5–10 minutes and, although it may be uncomfortable, it is not painful.

Large loop excision of the transformation zone – LLETZ

LLETZ is the most common treatment for removing abnormal cells from the cervix. It is sometimes called LEEP (loop electro-surgical excision procedure). It takes about 5 to 10 minutes and is usually done under local anaesthetic as an outpatient procedure. Sometimes, if a larger area of the cervix is treated, a general anaesthetic may be used.

Once you are in a comfortable position, the doctor will put some local anaesthetic onto the cervix to numb it. The doctor uses the colposcope to see a magnified image of your cervix (see diagram) and then, with a thin wire loop, cuts out the abnormal tissue. The loop is heated with an electric current, which cuts and seals the tissue at the same time.

The tissue removed will be sent off to a laboratory to be checked to make sure all of the abnormal cells have been taken away. If the cells on the outer edge of the sample are normal, you won’t need any more treatment. However if there are abnormal cells along the edge it may mean there are still some cell changes on your cervix and you will need another colposcopy to check.

LLETZ is not usually painful, but you may experience a period-like pain or a burning sensation. After the treatment, you may have some light bleeding or discharge which can last for a couple of weeks.

Cone biopsy

This is a way to diagnose CIN if the abnormal area cannot be seen clearly with a colposcope. It can also be used as a treatment for CIN. A small, cone-shaped piece of cervix, containing the abnormal cells, is removed. This is usually done under local anaesthetic, using a laser as a 'knife'.

Laser therapy or laser ablation

Under local anaesthetic, a laser beam is pointed onto the abnormal areas of the cervix and the cells are destroyed. During the treatment you may notice a slight burning smell from the laser; this is quite normal.

Cold coagulation

This is a misleading name, as the abnormal cells are removed by heating, not freezing. After a local anaesthetic to numb the cervix, a hot probe is placed onto its surface.

Cryotherapy

You will be given a local anaesthetic, and a probe will be put on the cervix to freeze the abnormal cells. Cryotherapy has a slightly lower success rate than the other treatments for CIN and so it is less commonly used.

Hysterectomy

A hysterectomy is an operation to remove the womb.  It is sometimes done for persistent or severe CIN if women have other gynaecological problems and they are past childbearing age, or do not want to have more children. For women who have not yet had the menopause, the ovaries will not be removed with the womb, so this treatment will not bring on an early menopause. Contact our nurses for more information about hysterectomy.

Unless you have had a hysterectomy or possibly a LLETZ or cone biopsy, you will be able to go home from hospital on the day that you are treated.

Most women feel fine after LLETZ, cone biopsy, laser therapy, cryotherapy or cold coagulation, but some women feel slightly unwell for a few hours. It is a good idea to have the day off work, in case you need to go home and rest. Also, many women find it helps to bring a friend or relative to support them and drive them home.

If your treatment was done under local anaesthetic, you may have some period-type pains for the rest of the day once the anaesthetic has worn off. You should expect to have some bleeding or discharge for a few days after these treatments. This usually stops within two weeks but may last for up to 4–6 weeks. The bleeding should not be heavier than a light period and should get steadily lighter.

You should contact your GP or the clinic where you had your treatment if:

• the bleeding starts to get heavier
• the discharge starts to smell (which can mean that you have an infection)
• you have any other concerns.

Your doctor or nurse will probably advise you not to have sex for at least three to four weeks after your treatment to allow the cervix to heal properly. Treatments for CIN will not have any effect on your ability to enjoy sex once the cervix has healed. You may be advised not to use tampons for a few weeks. You should feel completely back to normal in about six weeks at the very most.

Research has shown that the treatments for CIN are usually very successful. Those with CIN 3 in particular may still be at risk of further problems developing in the future. But all women who have had treatment still need to continue with regular cervical screening tests.

After any treatment for CIN you will need to be monitored for a time to check that the treatment has been successful.

If you had CIN 2 or 3, or cervical glandular intraepithelial neoplasia, you may have cervical screening tests six months and 12 months after treatment. You will then have a cervical screening test every year for nine years.

If you had treatment for CIN 1, screening may be done six months, 12 months and 24 months after treatment. If all these tests show a normal result, you will go back to routine screening; having cervical screening tests every three to five years, depending on your age.

Abnormal cells come back after treatment in between one in ten and one in twenty women. If this happens, you will be invited for another colposcopy and further treatment if necessary. Usually an excisional type of treatment (loop excision, laser excision or cone) is recommended for women who have had previous treatment.

If the abnormal cells come back more than once, you may be advised to have a hysterectomy, to prevent you from developing cancer of the cervix. It is also sometimes possible to remove just the neck of the womb in an operation known as trachelectomy. Trachelectomy is an experimental procedure that can be carried out on younger women who want to continue to have the possibility of becoming pregnant. You need to discuss all your options with your doctor.

Even if you have had a hysterectomy after an abnormal smear or biopsy you will still need to have regular check-ups as above, with smears taken from the top of the vagina (known as a vaginal vault smear). Your GP or gynaecologist can organise vault smears for you as they are not done as part of the NHS Cervical Screening Programme.