LEEP Procedure: precise, fertility-aware treatment for an abnormal smear in Turkey

What exactly is a LEEP, and what does it do?

LEEP, the loop electrosurgical excision procedure, removes the abnormal area of the cervix using a thin wire loop heated by an electric current. It is both a treatment and a test: the heated loop takes away the affected tissue in one piece, and that tissue is then examined under the microscope to confirm the diagnosis and check that the edges (margins) are clear. The procedure is done under local anaesthesia, takes only a few minutes, and leaves the healthy part of the cervix in place. Because it both removes the abnormal cells and provides a sample, LEEP is the most common treatment for high-grade cervical pre-cancer worldwide.

An abnormal smear and CIN — what do the results mean?

An abnormal smear usually means pre-cancerous cell changes, graded as cervical intraepithelial neoplasia (CIN), not cancer — and understanding the grade is the key to the right decision. Low-grade changes (CIN 1) often clear on their own and are usually watched rather than treated, while high-grade changes (CIN 2 and CIN 3) are more likely to persist and are the ones treated with LEEP to prevent progression. Almost all of these changes are caused by persistent infection with high-risk types of human papillomavirus (HPV), which is why HPV testing guides management alongside the smear. Knowing whether your result is low- or high-grade, and your HPV status, tells us whether to watch or to treat.

Source: American College of Obstetricians and Gynecologists (ACOG), management of abnormal cervical cancer screening

Who actually needs a LEEP?

Not every abnormal smear needs a LEEP; the decision rests on the grade of the change, your HPV status and whether the whole abnormal area can be seen on colposcopy. LEEP is most clearly indicated for confirmed high-grade dysplasia (CIN 2–3), for changes that persist despite follow-up, and when the lesion extends into the cervical canal where it cannot be fully assessed otherwise. Low-grade changes are usually watched, because many resolve without treatment, sparing the cervix an unnecessary procedure. We make this decision with you based on the full picture — smear, HPV and colposcopy — rather than treating an abnormal result reflexively.

What assessment is done before a LEEP?

A LEEP is not done on the smear result alone; it follows a clear assessment so that only women who truly need treatment have it. The usual path is an abnormal smear, followed by an HPV test, then colposcopy — a magnified look at the cervix — with a small biopsy of any suspicious area to confirm the grade. This tells us exactly where the abnormal cells are, how severe they are, and whether the whole area can be seen, all of which shape how much tissue needs to be removed. Taking the time to assess properly is what allows a precise, tissue-sparing LEEP rather than an over-large excision.

How is the LEEP carried out?

The LEEP itself is quick and is done in an outpatient setting under local anaesthesia, without the need for general anaesthesia in most cases. After numbing the cervix, the abnormal area is removed with a fine wire loop while colposcopy guides the exact extent, and a small amount of heat seals the area to limit bleeding. The removal takes only a few minutes, and the tissue is sent straight away for examination, including the margins. Most women feel only mild cramping during and after, and can go home the same day with simple aftercare advice.

LEEP or cone biopsy — what is the difference?

LEEP and cold-knife conisation both remove a cone-shaped piece of the cervix, but they differ in how and how much. A LEEP uses a heated wire loop under local anaesthesia and removes a smaller, shallower piece, which usually means less tissue lost and a lower impact on future pregnancy. A cold-knife cone uses a scalpel, is usually done under general anaesthesia and removes a larger piece, and is chosen for selected cases — for example when the canal is involved or when a clear, un-heated margin is essential. We choose between them according to the lesion, your age and your fertility plans, favouring the most conservative option that treats the disease.

Source: World Health Organization (WHO), treatment of cervical pre-cancer lesions

What are the risks and side effects of LEEP?

LEEP is safe and very well tolerated, but like any procedure it has some risks, which we explain openly. In the short term, light bleeding and a watery or brownish discharge for a couple of weeks are normal, while heavier bleeding or infection is uncommon. Over the longer term, scarring can occasionally narrow the cervical canal (cervical stenosis), reported in roughly 1 to 19 percent of cases depending on how much tissue is removed, and this is one reason we keep the excision conservative. Removing a larger or deeper piece can also slightly raise the chance of preterm birth in a later pregnancy, which is why the amount taken is matched carefully to the disease.

Source: Royal College of Obstetricians and Gynaecologists (RCOG), cervical excision and pregnancy outcomes

Can the abnormal cells come back after LEEP?

LEEP cures most women, but the abnormal cells can return, so it is not a guarantee that the problem is gone forever. Recurrence is around 10 percent overall and is more likely when high-risk HPV persists or when the margins of the removed tissue are not clear. Most recurrences appear within the first two years, which is exactly why structured HPV and smear follow-up after a LEEP is so important. We are honest that clearing the visible disease is not the same as clearing HPV, and we build a follow-up plan to catch any return early.

Source: National Institute for Health and Care Excellence (NICE), cervical screening and management of CIN

Will LEEP affect my fertility and future pregnancies?

For most women LEEP does not reduce the ability to conceive, and a well-judged, conservative procedure keeps pregnancy risks low. The main consideration is that removing a larger amount of cervical tissue can slightly increase the risk of preterm birth or early waters breaking in a later pregnancy, and this risk relates to how much length and volume are taken. When only a modest, tissue-preserving amount is removed, studies have not shown an increase in miscarriage or premature birth. Because of this, in women who still want children we plan the excision to be as conservative as the disease safely allows, and we discuss timing relative to pregnancy plans.

What is our approach to LEEP and abnormal smears?

At the heart of our approach is treating the disease while protecting the cervix: removing exactly what is needed, no more, and only when treatment is truly indicated. We assess each woman on the full picture — her smear, her HPV status, her colposcopy and biopsy, her age and her fertility plans — and we are as willing to watch a low-grade change as to treat a high-grade one. Where LEEP is right, we keep the excision conservative and tissue-preserving, especially for women who want children, and we send every specimen for careful margin assessment. As Associate Professor Dr. Cengiz Andan and our team, we believe that an honest explanation of what an abnormal smear does and does not mean, and a clear follow-up plan, matter as much as the procedure itself.

Why does experience matter for a procedure like LEEP?

Although LEEP is a short outpatient procedure, the judgement behind it — what to remove, how much, and when to watch instead — is where experience counts most. Taking too little risks leaving disease and positive margins; taking too much can affect a future pregnancy, so the balance requires careful colposcopic skill and sound clinical judgement. The 18 years of experience of Associate Professor Dr. Cengiz Andan, across more than 2,000 gynaecological procedures and a broad practice in women's health, supports a precise, fertility-aware approach to cervical pre-cancer. Even so, we want to be clear that every procedure carries some risk and that results can vary from person to person, which is why follow-up matters.

How does recovery and the return home work?

Recovery after LEEP is quick, because there is no abdominal wound and the procedure is done as a day case. Most women have light bleeding and a watery or brownish discharge for up to a couple of weeks, and are advised to avoid tampons, intercourse and swimming for a few weeks while the cervix heals. Since there is no surgical incision, a flight home is usually possible within a day or two. Complications are rare, but if a problem arises after you return we remain reachable, coordinate with your doctor at home, and handle the histology, margin result and follow-up plan remotely, with your reports prepared so you can give them to your own doctor.

What follow-up is needed after LEEP?

Follow-up is an essential part of LEEP, not an optional extra, because clearing the visible cells is not the same as clearing the underlying HPV. After the procedure, the histology and margin result are reviewed, and a schedule of HPV testing and smears is arranged, usually beginning around six months later, to confirm the abnormal cells are gone. If high-risk HPV persists or a smear is abnormal again, further assessment is arranged early, since most recurrences happen within the first couple of years. For international patients this follow-up lends itself well to remote support, coordinated with your doctor at home.

Treatment in Europe or in Turkey — what is the difference?

For a LEEP the difference between Europe and Turkey is not the quality of care but access and cost. The same colposcopy-guided technique and the same international guidelines for managing abnormal smears are followed in both; the gap comes from the exchange rate and lower operating costs, which lower the price rather than the standard. For many women an added difference is being able to move from an abnormal result to assessment and treatment quickly, with one responsible doctor, instead of waiting weeks between each step.

How does the process, accommodation and follow-up work from abroad?

For patients coming from abroad, the process begins with a digital review of your results before travel and is completed with a short stay in Turkey. You first share your smear, HPV and any colposcopy or biopsy reports, and discuss the plan and approximate cost in an online pre-consultation. Because LEEP is a day-case procedure, a stay of about 3–5 days is usually enough, covering the colposcopy and assessment, the procedure and a short review. A flight home is usually possible within a day or two, as there is no abdominal wound, and your histology and margin result are shared with you and your own doctor once ready.