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 journalArticlepeer-review

77 Citations (Scopus)


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
Issue number11
Early online date7 Jul 2009
Publication statusPublished - Oct 2009


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


Dive into the research topics of 'After-effects reported by women following colposcopy, cervical biopsies and LLETZ: results from the TOMBOLA trial'. Together they form a unique fingerprint.

Cite this