Should my young sister get a LEEP or wait and see?

October 26, 2007 3:45 PM

GirlpartsFilter: Please help my sister decide if LEEP is the right option. Her doctor gave her the choice and she has reservations.

My sister is 23. She had an abnormal pap (her first abnormal ever) and went in for a colposcopy. She has a high grade abnormality. Her doctor said that she could wait and come in for another check up in 3 months, by which point it might clear up, or she could have a LEEP done.

The doctor mentioned that if the abnormality recurs and she has to get another LEEP, she could be infertile. From what the Dr. said (and my research verifies), she most likely will not need another LEEP later on. But there is a possibility. (From everything I've seen, it looks like one procedure is fine and doesn't do too much to fertility, but two and you might not have enough cervix left to retain the pregnancy. Please correct if I am wrong.)

She has no children but eventually would like some and is worried about risking her 1 out of 2 shots at the LEEP when she is still so young.

Further complicating the situation is that while she is home in Boston now, she is supposed to be doing a fellowship in the republic of Georgia and will go back there between appointments. She saw a doctor there and had a terrible experience,which is why she is home with a doctor she trusts.
I am worried about her waiting and being nervous and alone in Georgia for three months, so I would like to advise her to get the LEEP done now. However, she does have very valid concerns about her fertility, and if the doctor thinks it is ok to wait and see, she might want to let it try and clear up on its own.

Please give any advice, anecdotes, statistics about recurrence (of high grade abnormalities or of the need for a second LEEP), or information that might help her make a decision or help me talk her through it.

I have seen the these threads (12597 and 38963).

posted by rmless to health & fitness (11 comments total)

dude. this described my exact situation last year (but no big sister to watch out for me.) but there is actually another option that you can explor: TCA treatment. basically you get your cervix washed with weak acid solution a few times (in the doctor's office, doesn;t hurt or anything). this stimulates the cervix to slough off the bad cells, supposedly. i don't think there's really any downside to it- if it doesn't work then you can go ahead and get the leep. hope that helps.
posted by genmonster at 3:58 PM on October 26, 2007

Here is some information from the American Society for Colposcopy and Cervical Pathology which talks about treatment of high grade lesions.

I have never heard of using TCA treatment to treat a high grade cervical lesion.

If your sister truly has a high grade lesion, then the standard of care is a LEEP procedure. However, I can understand her doctor's reasoning for watchful waiting, as high grade lesions in young women can regress spontaneously. You will see in the link I posted that there are "ASCCP guidelines to follow, rather than treat, young women with CIN 2 on biopsy if they are deemed reliable for follow-up and "understand the risks of occult disease." It sounds like your sister's doctor is really following the guidelines by giving her information and options - though sometimes, in cases like these, I think patients might just want to have a path laid out for them rather than be burdened with the decision.

Is your sister a smoker? If so, she definitely should quit now to decrease her risk of progression of the lesion.

I really hope all goes well for your sister.
posted by tuff at 4:16 PM on October 26, 2007

She is not a smoker, but thanks. I was just reading that link myself when you posted! I am glad she has a responsible doctor, but you're right, tuff, it doesn't make the decision easier.
posted by rmless at 4:17 PM on October 26, 2007

I got a LEEP done. I was kind of pissed about it, since it was during a surgery for an entirely different reason--while down there, the doctor noticed the lesions and decided to just go ahead and do the LEEP without my consent. I hadn't even known my pap smear was abnormal! After the surgery he wouldn't tell me what the lesiions were like or how bad they were--just that he removed them. It was swell. This is the first I've heard about the infertility issues; I am glad I've decided to not have biological children otherwise I'd be even MORE pissed.

Anyway, while I didn't feel sore from the procedure the next week or so was freaky from the charred dead tissue slowly making its way out of my body. My crotch smelled like a barbeque gone horribly wrong. Of course, you can't have penetration for a while to let things heal.

But I got it done and haven't had an abnormal pap since. So it worked for me. If I were your sister and I was very concerned about the infertility, I would wait and see.
posted by schroedinger at 5:09 PM on October 26, 2007

I took the wait-and-see approach after a colposcopy. My abnormality, which was fairly small, cleared up and has not come back. I made some pretty big lifestyle changes though and did everything I could to boost my immune system.
posted by pluckysparrow at 6:19 PM on October 26, 2007

Do they not still do cryosurgery as an option? Similar to the acid treatment mentioned above, the surface of the cervix is frozen with liquid nitrogen, cells die and slough, etc. I don't know if it's an option for severe abnormalities, though. I had it done about 15 years ago, and while it's not high on my scale of things I'd choose to do for fun, it wasn't much worse than the biopsy.
posted by Lyn Never at 7:52 PM on October 26, 2007

If memory serves, I did wait-and-see. That is, I got one abnormal pap, and my doctor had me come back in 6 months for another, which was also abnormal. Then we decided to do the LEEP. I had had on-and-off abnormal paps for several years. Since the LEEP, they've all been normal. I was moderately freaked out about the whole thing for a while, but the procedure was easy, there were no weird side effects or anything, and all has been well for a couple years.
posted by iguanapolitico at 8:54 PM on October 26, 2007

She may want to have a different lab repeat the PAP before she does anything else. There's abnormal and then there's "abnormal".

Come to think of it, there are probably some world class oncologists, histologists and pathologists in her area. She may want to be seen by one of these before proceeding.
posted by OlderThanTOS at 10:38 PM on October 26, 2007

The results scale goes something like ACUS (abnormal cells of unknown significance) < low-grade < high-grade < obvious cancerous changes. Unknown significance and low-grade are in the wait-and-see zone; high-grade is not.
posted by avocet at 11:17 PM on October 26, 2007

Your sis shouldn't be afraid to get a second opinion. I had two abnormal smear results and after a colposcopy decided to have LEEP, although I was given the 'wait and see' option. While the after effects weren't too pleasant, the procedure itself was pretty painless and I do know several other women who've had it done (some now have children). My cells were classed as CIN II (I being lowest and III being highest) and that influenced my decision. Although the lead time is very long, I didn't like the idea of something potentially cancerous hanging around inside me.
posted by poissonrouge at 1:31 AM on October 27, 2007

She waited and saw... and the bad cells went away! Looks like she is fine. Happy ending, cookies and juice for all.
posted by rmless at 3:03 PM on June 17, 2008