LEEP Procedure: Effectiveness, Risks, and Alternatives
A LEEP procedure removes the abnormal cells, but not always the virus. In 20-30% of women, HPV remains present after the procedure. What does that mean for you?
What is a LEEP procedure?
A LEEP procedure (also known as Loop Electrosurgical Excision Procedure or LLETZ) is a surgical intervention where a thin electric wire (loop) is used to remove abnormal tissue from the cervix. It is the most commonly performed treatment for CIN 2 and CIN 3 in the Netherlands.
The procedure is typically performed by a gynecologist under local anesthesia. The removed tissue is sent to the laboratory for examination. The goal is to remove all abnormal cells in a single session.
For many women, the LEEP procedure is an effective treatment. However, it is important to understand that the procedure has limitations, particularly regarding the underlying HPV virus.
How effective is a LEEP procedure?
A LEEP procedure successfully removes abnormal cells in most cases. However, statistics tell a more nuanced story than you might expect.
of margins are not clear of CIN after a LEEP procedure. This was shown in a meta-analysis of 66 studies involving 35,000 women.
Bron: Meta-analysis, 66 studies, 35,000 women
This means that for nearly a quarter of women, the abnormal cells were not completely removed. The margins still contain CIN tissue, which increases the risk of recurrence.
positive margins after LEEP in a 2020 study with 1,000 patients.
Bron: 2020 study, 1,000 patients
LEEP effectiveness in figures
| Data Point | Percentage | Source |
|---|---|---|
| Positive margins | 11.2% | 2020 study, 1,000 patients |
| Margins not clear of CIN | 23% | Meta-analysis 66 studies, 35,000 women |
| HPV persistence after LEEP | 15% | Various studies |
| CIN2+ development after LEEP | 23% | Long-term follow-up |
Why does HPV return after a LEEP procedure?
A LEEP procedure removes the abnormal tissue, but not necessarily the HPV virus. The virus can reside in cells around the treated area, in the vaginal wall, or elsewhere in the genital area. This explains why HPV can persist or return after a LEEP.
risk that HPV remains present after a LEEP procedure. The virus is not only located in the removed cells but can also be present in surrounding tissue.
Particularly concerning are the figures surrounding HPV 16, the most aggressive HPV type:
of women who were still HPV 16-positive after LEEP experienced CIN recurrence within 18 months. HPV 16 that remains present after treatment is a strong predictor of recurrence.
This underscores the importance of HPV monitoring after a LEEP procedure. Not just the tissue, but also the virus must be tracked. A negative check-up at the cell level is not enough if the virus is still present.
Risks and consequences of a LEEP procedure
In addition to the risk of incomplete removal and HPV persistence, there are other consequences you should consider:
- Scar tissue: The LEEP procedure leaves scar tissue on the cervix. This can reduce elasticity and cause issues during a potential pregnancy.
- Risk of premature birth: Because cervical tissue is removed, the cervix can become shorter and weaker. This increases the risk of premature birth in a future pregnancy.
- CIN recurrence: 23% of women develop CIN2+ after a LEEP procedure, despite the abnormal cells having been removed.
- Age as a risk factor: In women over 35 years old, the risk of recurrence of abnormal cells after LEEP is nearly 5x as high.
- Long-term follow-up required: After a LEEP procedure, you must be followed for 10 years with regular check-ups.
is the risk of abnormal cells returning after a LEEP procedure in women over the age of 35.
Still HPV positive after LEEP: what now?
If you are still HPV-positive after a LEEP procedure, it is understandably frustrating. You underwent a procedure, but the virus is not gone. This happens more often than you think, and it is important to know that follow-up steps are possible.
Action plan after LEEP with persistent HPV
Get a quantitative HPV test
Know which HPV type is still present and how high the viral load is. This determines the risk of recurrence. HPV 16 in particular requires extra alertness: 94% chance of CIN recurrence within 18 months.
Strengthen your immune system specifically
After a LEEP, it is extra important to support your immune system. Targeted supplements, proper nutrition, and stress reduction help your body clear the remaining virus.
Eliminate risk factors
Quit smoking, reconsider the contraceptive pill, reduce stress. These factors make it harder for the body to clear HPV after the procedure.
Consider escharotic treatment
Escharotic treatment can be used as a supplementary measure after a LEEP procedure. It treats any remaining abnormal tissue and can also improve scar tissue from the previous intervention.
Have your partner tested
Reinfection via your partner can be a reason why HPV returns after a LEEP. A sperm and penis test provides clarity.
Monitor regularly
After a LEEP, you must be followed for 10 years. Monitor not just the cell morphology, but also the viral load via a quantitative HPV test.
Alternatives to the LEEP procedure
The LEEP procedure is not the only option. Depending on your situation, there may be alternatives:
- Escharotic treatment: A non-invasive treatment that specifically removes abnormal cells without leaving scar tissue. Particularly suitable for CIN 1 and early CIN 2, and as a supplement after a LEEP procedure.
- Immunotherapy: Targeted strengthening of the immune system through supplements, nutrition, and lifestyle adjustments to clear the virus.
- Combined approach: At HPV Health, we combine multiple approaches for the best result: local treatment, immune support, and monitoring.
Important: escharotic treatment is not a replacement for a LEEP procedure in cases of severe abnormalities requiring immediate removal. It is a supplementary or alternative approach, depending on the severity and stage of the abnormalities.
Still HPV positive after LEEP? Or looking for an alternative?
At HPV Health, we help women who are still HPV-positive after a LEEP procedure or who are looking for an alternative approach. With comprehensive diagnostics and a tailored treatment plan, we work on clearing the virus.
Schedule an intake consultationExperiences after LEEP
“The scar tissue from the LEEP procedure has also disappeared. After my LEEP treatment, the HPV virus remained present and I suffered from scar tissue. The escharotic treatment not only addressed the virus, but the scar has also healed. I didn't expect that.”
Anja
PAP3A hrHPV, post-LEEP, PAP1, HPV negative
“I was referred for a LEEP procedure, but wanted to try an alternative first. After the program at HPV Health, my smear test was clean. Even my gynecologist was impressed with the result.”
Nathalie
CIN2/3, PAP1, HPV negative
LEEP vs. escharotic treatment
Treatment comparison
| Feature | LEEP Procedure | Escharotic Treatment |
|---|---|---|
| Method | Surgical (electric loop) | Local application of tincture |
| Anesthesia | Local anesthesia required | Not required |
| Scar tissue | Yes | No |
| Impact on pregnancy goals | Risk of premature birth | No adverse effect |
| HPV virus approach | Not directly | Supportive via immune system |
| Recovery time | Several weeks | None |
| Suitable for | CIN 2/3, severe abnormalities | CIN 1, early CIN 2, post-LEEP |
Veelgestelde vragen
How long does recovery take after a LEEP procedure?
Can I still get pregnant after a LEEP procedure?
What are the chances of CIN returning after a LEEP procedure?
Do I still need check-ups after a LEEP procedure?
Can escharotic treatment be used after a previous LEEP procedure?
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