What is a LEEP procedure? 11 things to know about loop electrosurgical excision

A loop electrosurgical excision procedure, or LEEP, is a preventive procedure in which a medical provider uses a wire loop heated by electricity to remove abnormal cells from the cervix before cancer develops.

But how would you know if you need a LEEP, what happens during the procedure and how long does it take to recover from one?

Here, I’ll answer these questions and more.

Who needs a LEEP?

When your HPV and/or Pap test has abnormal results, the next step is often a colposcopy. This procedure allows a medical provider to examine the surface of your cervix more carefully using a special device called a colposcope. They will then perform biopsies on any suspicious areas that they find.

If the biopsy results show a type of precancerous cell called high-grade dysplasia, then a LEEP is often the next step. Women are sometimes told that they need to have a hysterectomy, but this is usually not the case. While it’s important to catch cancer before it develops, women should not undergo unnecessary procedures. And, a LEEP prevents the need for a hysterectomy, in most cases.

Is a LEEP considered major surgery?

No. A LEEP is a relatively simple procedure that can be performed in an outpatient setting. It is not major surgery. Years ago, it was performed in the operating room, and some hospitals still do that. But here at UT MD Anderson and many other hospitals, LEEPs can be performed safely in the clinic.

What happens during a LEEP?

First, your medical provider will numb the cervix using local anesthesia. Then, they’ll remove the abnormal cells using a heated wire.

The procedure itself only takes about 10 to 15 minutes. The entire visit usually lasts no longer than an hour.

Do I need to do anything special to prepare for a LEEP?

You should stop taking certain medications, such as blood thinners, before the procedure. Talk to your care team to see what else they recommend.

Does a LEEP hurt?

A LEEP is usually mildly uncomfortable, rather than painful. So, you may feel some discomfort while the local anesthetic is being administered.

After the anesthesia takes effect, you shouldn’t experience any pain at all, though you may feel some pressure. The best comparison I can give you is probably to a simple procedure you’d have done at the dentist.

How long does it take to recover from a LEEP?

Most people can resume normal activities the same day, with full healing taking about four weeks.

You can typically return to work within one day, and start exercising again shortly thereafter. However, you should refrain from having sex or using tampons for at least four weeks after a LEEP so your cervix can heal completely.

What are the risks and side effects associated with a LEEP?

A LEEP has similar risks to other surgical procedures. These include prolonged bleeding and infection. But those occur only very rarely.

Side effects may include discomfort, cramping and bleeding similar to a period.

Can a LEEP impact your fertility or pregnancy?

A LEEP isn’t likely to impact your ability to conceive, but there’s a small risk of future pregnancy loss or pre-term labor associated with it. Still, the vast majority of women who have LEEPs go on to have healthy pregnancies and healthy babies.

Reach out to your care team if you have any concerns. They can address your questions before the procedure and ensure that a LEEP is the right choice for you.

How will I know if a LEEP was effective?

We send the tissue removed during a LEEP to a pathologist for review. If the margins (or edges) of these tissue samples are positive for abnormal cells, you may need another LEEP.

You may also need another LEEP if we find abnormal cells during your follow-up visit six months later.

Once you’ve had a normal Pap test and/or negative HPV test, you’ll only need to come back every 6 or 12 months for repeat testing, depending on your care team’s recommendations. Women who’ve had a LEEP due to high-grade dysplasia must be followed closely for the next 25 years to make sure it does not recur.

Does a LEEP get rid of the human papillomavirus (HPV)?

A LEEP can eliminate the effects of an HPV infection by removing the abnormal cervical cells caused by the human papillomavirus (HPV). But it cannot kill the virus itself.

How common are LEEPs?

At UT MD Anderson, our gynecologists perform between 50 and 75 LEEPs a year. Our team performs an additional 150 to 200 a year through the UT MD Anderson Oncology Program at Lyndon B. Johnson Hospital.  

Though cervical cancer itself is rare, precancerous lesions are relatively common. Approximately 10% of women who undergo cervical cancer screening will have an abnormal Pap test and/or a positive HPV test. Less than 1% will have cancer. But 3% to 5% will have high-grade cervical dysplasia and need a LEEP.

Kathleen Schmeler, M.D., is a gynecologic oncologist and associate vice president of Global Oncology at UT MD Anderson.

Request an appointment at UT MD Anderson online or call 1-877-632-6789.