After-effects reported by women following colposcopy, cervical biopsies and LLETZ

results from the TOMBOLA trial

Linda Sharp, Seonaidh C Cotton, Claire Cochran, Nicola M Gray, Julian Little, Keith Neal, Margaret E Cruickshank, The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

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.
Original languageEnglish
Pages (from-to)1506-1514
Number of pages9
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume116
Issue number11
Early online date7 Jul 2009
DOIs
Publication statusPublished - Oct 2009

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Colposcopy
Biopsy
Pain
Hemorrhage
Menstruation
Observational Studies
Cell Biology
Anxiety
Randomized Controlled Trials

Keywords

  • adult
  • biopsy
  • cervix uteri
  • colposcopy
  • female
  • Great Britain
  • humans
  • menstruation
  • middle aged
  • pain
  • postoperative complications
  • treatment outcome
  • uterine hemorrhage
  • vaginal discharge
  • young adult

Cite this

Sharp, L., Cotton, S. C., Cochran, C., Gray, N. M., Little, J., Neal, K., ... The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group (2009). After-effects reported by women following colposcopy, cervical biopsies and LLETZ: results from the TOMBOLA trial. BJOG-An International Journal of Obstetrics and Gynaecology, 116(11), 1506-1514. https://doi.org/10.1111/j.1471-0528.2009.02263.x

After-effects reported by women following colposcopy, cervical biopsies and LLETZ : results from the TOMBOLA trial. / Sharp, Linda; Cotton, Seonaidh C; Cochran, Claire; Gray, Nicola M; Little, Julian; Neal, Keith; Cruickshank, Margaret E; The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group.

In: BJOG-An International Journal of Obstetrics and Gynaecology, Vol. 116, No. 11, 10.2009, p. 1506-1514.

Research output: Contribution to journalArticle

Sharp, L, Cotton, SC, Cochran, C, Gray, NM, Little, J, Neal, K, Cruickshank, ME & The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group 2009, 'After-effects reported by women following colposcopy, cervical biopsies and LLETZ: results from the TOMBOLA trial', BJOG-An International Journal of Obstetrics and Gynaecology, vol. 116, no. 11, pp. 1506-1514. https://doi.org/10.1111/j.1471-0528.2009.02263.x
Sharp, Linda ; Cotton, Seonaidh C ; Cochran, Claire ; Gray, Nicola M ; Little, Julian ; Neal, Keith ; Cruickshank, Margaret E ; The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group. / After-effects reported by women following colposcopy, cervical biopsies and LLETZ : results from the TOMBOLA trial. In: BJOG-An International Journal of Obstetrics and Gynaecology. 2009 ; Vol. 116, No. 11. pp. 1506-1514.
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abstract = "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.",
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AU - Sharp, Linda

AU - Cotton, Seonaidh C

AU - Cochran, Claire

AU - Gray, Nicola M

AU - Little, Julian

AU - Neal, Keith

AU - Cruickshank, Margaret E

AU - The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

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N2 - 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.

AB - 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.

KW - adult

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KW - cervix uteri

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KW - female

KW - Great Britain

KW - humans

KW - menstruation

KW - middle aged

KW - pain

KW - postoperative complications

KW - treatment outcome

KW - uterine hemorrhage

KW - vaginal discharge

KW - young adult

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M3 - Article

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JO - BJOG-An International Journal of Obstetrics and Gynaecology

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