After‐effects reported by women following colposcopy, cervical biopsies and LLETZ: results from the TOMBOLA trial

• Published in: BJOG : an international journal of obstetrics and gynaecology 2009-10, Vol.116 (11), p.1506-1514
• Main Authors: Sharp, Linda, Cotton, Seonaidh, Cochran, Claire, Gray, Nicola, Little, Julian, Neal, Keith, Cruickshank, Maggie
• Format: Article
• Language: English
• Subjects: Adult; After‐effects; Biological and medical sciences; Biopsy; Biopsy - adverse effects; Biopsy - methods; Cervical cancer; Cervix Uteri - pathology; Cervix Uteri - surgery; colposcopy; Colposcopy - adverse effects; Colposcopy - methods; complications; Female; Gynecology; Gynecology. Andrology. Obstetrics; Humans; LLETZ; Medical procedures; Medical sciences; Medical screening; Menstruation; Middle Aged; Pain - etiology; Postoperative Complications - etiology; punch biopsies; Treatment Outcome; United Kingdom; Uterine Hemorrhage - etiology; Vaginal Discharge - etiology; Young Adult
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2009.02263.x

Objective  Few studies have investigated physical after‐effects of colposcopy. We compared post‐colposcopy self‐reported pain, bleeding, discharge and menstrual changes in women who underwent: colposcopic examination only; cervical punch biopsies; and large loop excision of the transformation zone (LLETZ). Design  Observational study nested within a randomised controlled trial. Setting  Grampian, Tayside and Nottingham. Population  Nine hundred‐and‐twenty‐nine women, aged 20–59, with low‐grade cytology, who had completed their initial colposcopic management. Methods  Women completed questionnaires on after‐effects at approximately 6‐weeks, and on menstruation at 4‐months, post‐colposcopy. Main outcome measures  Frequency of pain, bleeding, discharge; changes to first menstrual period post‐colposcopy. Results  Seven hundred‐and‐fifty‐one women (80%) completed the 6‐week questionnaire. Of women who had only a colposcopic examination, 14–18% reported pain, bleeding or discharge. Around half of women who had biopsies only and two‐thirds treated by LLETZ reported pain or discharge (biopsies: 53% pain, 46% discharge; LLETZ: 67% pain, 63% discharge). The frequency of bleeding was similar in the biopsy (79%) and LLETZ groups (87%). Women treated by LLETZ reported bleeding and discharge of significantly longer duration than other women. The duration of pain was similar across management groups. Forty‐three percent of women managed by biopsies and 71% managed by LLETZ reported some change to their first period post‐colposcopy, as did 29% who only had a colposcopic examination. Conclusions  Cervical punch biopsies and, especially, LLETZ carry a substantial risk of after‐effects. After‐effects are also reported by women managed solely by colposcopic examination. Ensuring that women are fully informed about after‐effects may help to alleviate anxiety and provide reassurance, thereby minimising the harms of screening.