LEEP (loop electrosurgical excision procedure) is the standard in-office treatment for high-grade cervical dysplasia (CIN 2 and CIN 3). A thin wire loop is heated by electrical current and used to remove the transformation zone — the region of the cervix where the squamous and glandular epithelium meet and where virtually all cervical dysplasia and cervical cancer originates. The removed tissue is sent for pathologic examination to confirm the diagnosis and assess the margins.
LEEP achieves two clinical goals simultaneously: it treats the dysplasia by removing the affected tissue, and it provides a specimen for definitive histologic evaluation. LEEP is successful at achieving clear margins — meaning all abnormal tissue was removed — in over 90 percent of cases. When margins are positive on the LEEP specimen (abnormal cells present at the edge of the removed tissue), follow-up surveillance is intensified but additional immediate treatment is not always required.
Before the Procedure
LEEP is performed in the office, typically during or after the menstrual period. Taking ibuprofen 400 to 600mg one hour before the procedure reduces cramping. A pregnancy test is performed before LEEP. You should arrange not to drive immediately afterward if you feel lightheaded, and some women prefer to have someone drive them home as a precaution. No fasting is required.
Local Anesthesia
Local anesthetic (lidocaine with epinephrine) is injected into the cervix before the excision. The injection itself produces a brief stinging sensation and the epinephrine may cause brief palpitations or warmth — this is a normal response that passes quickly. The local anesthesia significantly reduces pain during the procedure. Some women feel pressure during the excision; most feel little to no sharp pain after the anesthesia takes effect.
The Excision
The wire loop is passed through the transformation zone of the cervix, removing it as a single specimen or in two passes. A light smoke plume (with a characteristic smell) is produced by the electrical current — this is normal. The procedure itself takes approximately 5 minutes. Monsel’s solution or silver nitrate is applied to the excision site to control bleeding. The entire office visit including preparation and recovery time is typically 30 to 45 minutes.
After the Procedure
Moderate cramping similar to menstrual cramps is expected for several hours after LEEP. A watery, dark discharge from Monsel’s solution is normal for one to three weeks. Light spotting is expected; heavier bleeding is uncommon but warrants a call to our office. Pelvic rest — no intercourse, tampons, or vaginal insertions — for four weeks is recommended to allow the cervix to heal. Strenuous exercise and heavy lifting are restricted for one week. Most women return to work and light activities the same day or the next day.
Results and Follow-Up
LEEP specimen pathology results are available within one to two weeks and are reviewed at a follow-up appointment with a clear explanation of what was found and what comes next. Post-LEEP surveillance with co-testing at 6 months, then annually for two years, is the standard follow-up pathway after successful LEEP for CIN 2 or CIN 3.
Contact our office promptly if after LEEP you experience:
- Heavy vaginal bleeding — soaking a pad in an hour or more
- Fever above 38°C (100.4°F) suggesting possible cervical infection
- Significant worsening pelvic pain beyond what was present immediately after the procedure
- Foul-smelling discharge suggesting infection
Highly Effective
LEEP achieves clear excision margins in over 90 percent of cases, with cure rates for CIN 2 and CIN 3 consistently above 90 percent in large studies. Post-treatment surveillance identifies the minority of cases with residual or recurrent dysplasia early — when re-treatment, if needed, is equally straightforward.
Diagnostic and Therapeutic
The LEEP specimen provides the definitive histologic evaluation of the entire transformation zone — confirming the CIN grade on biopsy, assessing margin status, and in rare cases identifying early invasive cancer that was not apparent on the colposcopy biopsy. This dual diagnostic and therapeutic function is one of the key advantages of excisional over ablative treatment approaches.
Office-Based Under Local Anesthesia
Performing LEEP in the office under local anesthesia avoids the cost, risk, and recovery associated with general anesthesia and an operating room visit. Most women tolerate the procedure well and return to normal activities the same day. The procedure is less resource-intensive and more accessible than surgical alternatives while achieving equivalent outcomes for the majority of CIN 2 and CIN 3 cases.
Dr. Andrei performs LEEP under local anesthesia with clear pre- and post-procedure guidance. No referral required.
Schedule a Gynecologic VisitEducational purposes only. Not medical advice. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.