CIN 2: the difficult choice
CIN 2 is a gray area. You are caught between watchful waiting and treatment. There is no single right answer, but there are more options than you might think.
What is CIN 2?
CIN 2 (Cervical Intraepithelial Neoplasia grade 2) means there are moderate abnormalities in the cells of your cervix. The HPV virus has caused changes in the bottom two-thirds of the lining (epithelium). The abnormalities go deeper than in CIN 1, but have not yet affected the entire tissue layer.
CIN 2 is not cancer. It is a precancerous stage that can spontaneously resolve in some women, but can also progress to CIN 3 if left untreated. This is why CIN 2 is the point where you must make an important choice.
What makes CIN 2 so tricky is that you are right in the middle: too serious to wait without concern, but potentially not serious enough to immediately undergo invasive treatment. This is a difficult dilemma, especially for women wishing to conceive.
of CIN 2 cases do not resolve spontaneously. With a persistent HPV infection of type 16, the risk of progression to CIN 3 is significantly higher.
Bron: RIVM / Dutch CIN Guidelines
The consideration: LEEP procedure for CIN 2
The standard treatment proposed by a gynecologist for CIN 2 is a LEEP procedure (also called LLETZ). This is a procedure where a portion of the cervix is cut away using an electrical loop. It is important to carefully weigh the pros and cons.
LEEP procedure for CIN 2: pros and cons
| Pros | Cons | |
|---|---|---|
| Effectiveness | 75-90% of abnormal cells are removed in a single procedure | The HPV virus itself is not removed. HPV remains present in 15-23% of cases |
| Speed | One-time procedure under local anesthesia, takes approx. 15 minutes | Recovery time of 4-6 weeks with restrictions |
| Certainty | The tissue is examined by a pathologist so the exact diagnosis is confirmed | The margins are not always easy to assess, with a 10-25% chance of HPV viruses and/or abnormal cells remaining. A follow-up smear test is done after six months to check if the abnormal cells and the HPV virus are gone. |
| Wish to conceive | Pregnancy is usually well possible after one LEEP procedure | Risk of cervical insufficiency and preterm birth increases, especially with repeated procedures |
| Scar tissue | — | Scar tissue can develop, along with narrowing and shortening of the canal and other complications |
Wishing to conceive and CIN 2
If you wish to conceive, the choice becomes even harder. A LEEP procedure removes a portion of the cervix, making it shorter. This increases the risk of:
- Cervical insufficiency: The cervix may open too early during pregnancy.
- Preterm birth: The risk of preterm birth (before 37 weeks) increases by 1.5 to 2 times after a LEEP procedure.
- Low birth weight: Related to preterm birth.
This is why more and more gynecologists are looking for alternatives for women with an active wish to conceive. In some hospitals, imiquimod (Aldara) is offered as an alternative. Imiquimod is a cream that activates the local immune system and has proven effective in 60-75% of women with CIN 2 in clinical trials.
Other options when wishing to conceive:
- Watchful waiting with intensive monitoring: For young women (<30 years), the gynecologist may decide to wait 6-12 months with frequent check-ups.
- Escharotic treatment: Removes abnormal cells without scar tissue and without risk to the cervix.
- Combination approach: Immune system support + local treatment for the best result without surgical risk.
Wishing to conceive and CIN 2? Discuss your options
At HPV Health, we help you make the right choice. We discuss all options, including alternatives to LEEP, and create a plan that fits your situation and your wish to conceive.
Schedule an intakeAlternatives to LEEP for CIN 2
Besides the standard LEEP, there are alternatives you can consider, depending on your situation:
Escharotic treatment
Escharotic treatment is a local treatment where a specially formulated tincture selectively destroys abnormal cells while leaving healthy tissue intact. The major advantage over LEEP: no scar tissue is formed and the cervix remains completely intact.
For CIN 2, escharotic treatment can be effective, but it is important to be realistic. CIN 2 goes deeper than CIN 1, and the treatment may require more sessions. Regular monitoring via colposcopy and HPV testing is essential to assess the result.
Immune system support
In addition to local treatment, strengthening your immune system is crucial with CIN 2. Research shows that targeted supplements can support the immune system in clearing HPV. Combined with lifestyle adjustments (quitting smoking, stress reduction, nutrition), you give your body the best chance.
The role of HPV Health in CIN 2
At HPV Health, we understand that CIN 2 is a stressful diagnosis with difficult choices. We help you in the following ways:
- Extensive diagnostics: We determine the exact HPV type and viral load, providing a better picture of your risk profile.
- Objective information: We discuss all options honestly: LEEP, watchful waiting, escharotic treatment, immune system support. No sales pitch, just a nuanced conversation.
- Tailored treatment plan: Customized to your situation, HPV type, age, and wish to conceive.
- Collaboration with your gynecologist: We always work complementarily. If LEEP is the best choice, we will tell you so honestly.
- Post-LEEP care: If you do choose LEEP, we help afterward with clearing the remaining HPV virus and preventing recurrence.
Experiences of women with CIN 2
“With a wish to conceive, I didn't want a LEEP procedure. My gynecologist agreed we could wait a while. At HPV Health, I received escharotic treatment and a comprehensive supplement plan. After 3 months, my abnormalities were back to CIN 1, and after 6 months, everything was clear.”
Nienke
CIN 2, wishing to conceive
“I hesitated for a long time: LEEP or not? HPV Health helped me make an informed choice. I chose the combination approach and am glad I took that chance. My last smear test was normal again.”
Anouk
CIN 2, HPV 16
“After my LEEP, the HPV virus wasn't gone. The abnormalities returned. Through HPV Health, I then had escharotic treatment plus supplements. Now the virus is no longer detectable either.”
Jennifer
CIN 2, after LEEP
Veelgestelde vragen
Can CIN 2 go away on its own?
How fast can CIN 2 get worse?
Can I get pregnant with CIN 2?
What is the difference between CIN 2 and CIN 3?
Do I need to have a LEEP procedure immediately for CIN 2?
Ready for the next step?
Schedule an intake and discover which holistic treatment suits you best.
Schedule an intake