Group members and the writing and analysis committee are listed in the Appendix.
After-effects reported by women following colposcopy, cervical biopsies and LLETZ: results from the TOMBOLA trial
Article first published online: 7 JUL 2009
© 2009 The Authors Journal compilation © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 116, Issue 11, pages 1506–1514, October 2009
How to Cite
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 & Gynaecology, 116: 1506–1514. doi: 10.1111/j.1471-0528.2009.02263.x
- Issue published online: 16 SEP 2009
- Article first published online: 7 JUL 2009
- Accepted 11 May 2009. Published Online 7 July 2009.
- punch biopsies
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.