A LEEP, or loop electrosurgical excision procedure, is an outpatient treatment that removes precancerous cells from the cervix using a thin wire loop heated by electrical current. It’s one of the most common ways to treat abnormal cervical cell changes found after a Pap smear or colposcopy, and the entire procedure typically takes less than 30 minutes.
How LEEP Works
During a LEEP, a thin wire loop carries a low-voltage electrical current that heats the wire. Your doctor inserts a speculum (the same instrument used during a Pap smear), then passes the heated loop across the surface of your cervix. As it moves, the loop cuts away a thin layer of tissue containing the abnormal cells. The removed tissue is sent to a lab so a pathologist can examine the cells more closely and confirm the edges of the sample are free of abnormal cells.
You’ll receive a local anesthetic injected into the cervix to numb the area. Most people feel pressure and mild cramping, similar to a period cramp, but not sharp pain. The actual cutting takes only a few minutes. After the tissue is removed, a yellow paste called Monsel’s solution is often applied to the cervix to stop bleeding and promote healing.
Why Doctors Recommend It
LEEP is typically recommended when a colposcopy and biopsy reveal moderate to severe precancerous changes on the cervix. These changes are graded on a scale: low-grade changes often resolve on their own, but higher-grade changes carry a real risk of progressing to cervical cancer if left untreated. LEEP removes those cells before they have a chance to become cancerous, and the tissue sample lets your doctor verify the full extent of the abnormality.
The procedure serves two purposes at once. It’s both a treatment (removing the problem cells) and a diagnostic tool (giving the lab a larger tissue sample than a standard biopsy). This makes it especially useful when biopsy results are unclear or when abnormal cells extend into the cervical canal where they’re harder to see.
Success and Recurrence Rates
LEEP clears abnormal cells in the vast majority of cases. In a five-year follow-up study, the recurrence rate after LEEP was about 8%, meaning more than 9 out of 10 people had no return of precancerous cells. Roughly 11% of LEEP patients had positive surgical margins, meaning some abnormal cells were found at the edge of the removed tissue. This doesn’t necessarily mean the procedure failed, since the body often clears remaining cells on its own, but it does mean closer follow-up is needed.
After a LEEP, you’ll typically have Pap smears and sometimes HPV testing at regular intervals to make sure the abnormal cells haven’t returned. Most recurrences are caught early through this monitoring and can be treated again.
What Recovery Looks Like
Most people go home the same day and can return to normal activities within a day or two. You can expect some vaginal discharge for two to three weeks afterward. This discharge is often brownish-black in color, which can look alarming but is completely normal. It comes from the Monsel’s paste applied during the procedure, which typically comes off in small clumps within about four days. Some people have light spotting instead, and others have no discharge at all.
For roughly three to four weeks after the procedure, you’ll need to avoid inserting anything into the vagina. That means no tampons, no sexual intercourse, and no douching. You should also skip heavy exercise and lifting during the first week or so. These restrictions give the cervix time to heal and reduce the risk of bleeding or infection.
Risks and Complications
Serious complications from LEEP are rare, occurring in less than 1% of cases. Bleeding is the most common issue, though it’s still uncommon. Pelvic infection is possible but rare enough that preventive antibiotics aren’t routinely prescribed. Some people develop cervical stenosis, a narrowing of the cervical canal from scar tissue, which can occasionally cause problems with menstrual flow or future procedures.
Call your doctor if you experience heavy bleeding (soaking through a pad in an hour), fever, or foul-smelling discharge in the weeks after the procedure. Mild cramping and light spotting are expected and don’t require medical attention.
Timing the Procedure
When your LEEP is scheduled during your menstrual cycle can make a difference. A randomized trial found that having the procedure during the first half of your cycle (the follicular phase, between the end of your period and ovulation) significantly reduces bleeding. Women who had LEEP during the second half of their cycle experienced nearly seven times the rate of late postoperative bleeding compared to those treated in the first half (20.6% versus 2.8%). If you have flexibility in scheduling, the first half of your cycle is the better window.
Effects on Future Pregnancy
LEEP does not prevent you from getting pregnant. However, removing tissue from the cervix can slightly increase the risk of preterm birth in future pregnancies. The cervix plays a structural role in keeping a pregnancy in place, and removing a layer of tissue can weaken it. Research published in JAMA Network Open found that LEEP is associated with a higher risk of preterm birth and early rupture of membranes compared to the general population.
The amount of tissue removed matters. A single, standard LEEP removes a thin layer and carries a relatively modest increase in risk. If you’re planning a future pregnancy, let your obstetrician know about your LEEP history. They can monitor your cervical length during pregnancy with ultrasound and intervene early if it begins to shorten. For most people, pregnancy after LEEP proceeds normally.
What Happens After the Results
The tissue removed during your LEEP goes to a pathology lab, and results typically come back within one to three weeks. Your doctor will review whether the margins are clear, meaning no abnormal cells were found at the edges of the tissue. Clear margins are a good sign that all precancerous cells were removed. If margins are positive, your doctor may recommend closer surveillance with more frequent Pap smears or, less commonly, a repeat procedure.
Regardless of the margin results, follow-up testing is standard. Most guidelines call for a Pap smear or HPV test at 12 months, then continued monitoring for several years. The goal is to catch any recurrence early, when it’s easiest to treat. HPV, the virus responsible for most cervical precancers, can persist in the body, so ongoing screening remains important even after a successful LEEP.