After-effects reported by women following colposcopy, cervical biopsies and LLETZ: results from the TOMBOLA trial

BJOG. 2009 Oct;116(11):1506-14. doi: 10.1111/j.1471-0528.2009.02263.x. Epub 2009 Jul 7.


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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biopsy / adverse effects
  • Biopsy / methods
  • Cervix Uteri* / pathology
  • Cervix Uteri* / surgery
  • Colposcopy / adverse effects*
  • Colposcopy / methods
  • Female
  • Humans
  • Menstruation
  • Middle Aged
  • Pain / etiology*
  • Postoperative Complications / etiology*
  • Treatment Outcome
  • United Kingdom
  • Uterine Hemorrhage / etiology*
  • Vaginal Discharge / etiology*
  • Young Adult