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

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The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group (Including:

Cruickshank, Maggie, Murray, Graeme, Parkin, David, Smart, Louise, Walker, Eric, Waugh, Norman, Avis, Mark, Chilvers, Claire, Fielding, Katherine, Hammond, Rob et al.
). (2009) After-effects reported by women following colposcopy, cervical biopsies and LLETZ : results from the TOMBOLA trial. BJOG: An International Journal of Obstetrics & Gynaecology, Vol.116 (No.11). pp. 1506-1514. doi:10.1111/j.1471-0528.2009.02263.x

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Official URL: http://dx.doi.org/10.1111/j.1471-0528.2009.02263.x

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Abstract

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.

Item Type: Journal Article
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) > Warwick Evidence
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title: BJOG: An International Journal of Obstetrics & Gynaecology
Publisher: Wiley-Blackwell Publishing, Inc
ISSN: 1470-0328
Official Date: October 2009
Dates:
DateEvent
October 2009Published
Volume: Vol.116
Number: No.11
Page Range: pp. 1506-1514
DOI: 10.1111/j.1471-0528.2009.02263.x
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access

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