it's a LEEP year!!!
March 2, 2009 10:04 AM   Subscribe

I decided on my obgyn last minute, when the one I wanted wasnt taking new patients. My pap came back abnormal and I had to have a biopsy. They found I have moderate cervical dysplasia. I am scheduled to get a LEEP procedure.

I do not like my current obgyn and scheduled an appointment with a new one to get a second opinion. I will have to wait nearly a month to see her and then even longer to have the LEEP performed, if need be. Soooo, what are some experiences with waiting? Should I do it, or go ahead and have the LEEP? I have heard others wait and the abnormalities go away, but I'm not sure how wise this is with "moderate" cervical dysplasia? My current obgyn is cold and scary. I have not met my new obgyn but her reviews are wonderful and she is all about natural birth and other things that sound promising for me....
posted by anonymous to Health & Fitness (15 answers total)
Go ahead and get the LEEP. Don't delay just because of your current obgyn's attitude. You need this procedure. When you switch to the new obgyn, make sure your records are sent over. Then, she can help you with whatever the results of the LEEP may be.
posted by ocherdraco at 10:09 AM on March 2, 2009

Actually, I would argue that it is probably OK to wait a short period. This has to do with the biology of the disease. Nearly all (>95%) of cervical cancer, and therefore, much of the cervical dysplasia, is due to HPV. The biology of oncogenic (cancer causing) HPV is such that many infections and the resulting dysplastic changes, resolve. The problem, of course, is that not all of them do, and it's not possible to know which dysplastic lesion is going to go away and which is going to turn into a higher-grade lesion, or worse, an invasive cancer. This is why when you find a lesion, you treat it.

That said, as long as you're aware of the lesion and full-well intend to go through with having it treated (which I would consider a "must do"), you're OK waiting the couple of months. It can take years for a squamous intraepithelial lesion (SIL) to form, and longer for an invasive cervical cancer to form. This is borne out by the epidemiology of cervical cancer: rare in 20 somethings and 30 somethings. More common in 50-60 year olds.

Long story short: it probably will be OK to wait a couple of months for the sake of a much improved physician/patient relationship, but don't blow this off.

(Disclaimer: I'm a pediatrician, not an OB/GYN, so I've never treated cervical dysplasia; however, I was an up-front witness to the clinical development of the current HPV vaccine).
posted by scblackman at 10:21 AM on March 2, 2009 [1 favorite]

Disclaimer: I have never needed a LEEP procedure and only know what it is from googling.

If your current Ob-Gyn is "cold and scary" do not have this procedure with him/her. This procedure seems mildly invasive, and can have some bleeding and mild pain afterwards - why trust someone you don't like (and clearly doesn't like patients) with your care?

It seems that Cervical Dysplasia is a pre-cancerous condition, but according to this site, "it can take 10 years or longer for cervical dysplasia to develop into cancer. " I personally would rather wait to have all of this taken care with someone who I trusted and was actually nice to me.

I am not a doctor, nor have I had this procedure...
posted by anthropoid at 10:26 AM on March 2, 2009

I think you'll be fine to wait.

I got my first abnormal pap when I was 17, and my GP wanted to do a cone biopsy immediately. I opted for a second opinion from an ob/gyn. They determined that the displaysia wasn't bad enough to warrant a biopsy at that time, but simply scheduled quarterly paps to keep an eye on it. It wasn't until 4 years later that the displaysia progressed enough to have the biopsy and LEEP.

Of course, IANAD. But if you can get in to see the new doctor in a month, and you would be much more comfortable with her, I don't think it's unreasonable to put the procedure off for such a short amount of time. I'm pretty sure it took me that long to get my second opinion.
posted by thejanna at 10:30 AM on March 2, 2009

I would wait for the second opinion. Having had the LEEP procedure unnecessarily- you only want to do it unless you absolutely must. I ended up having a LEEP do to an error reading my PAP- I had tested negative for HPV. I changed doctors immediately and my current one says to wait a bit after a bad PAP, then re-test, and THEN make a decision.
posted by hellboundforcheddar at 10:34 AM on March 2, 2009

I would DEFINITELY have the LEEP, unless you somehow get different results from your new doctor. For LSIL (the low-grade abnormalities) waiting is sometimes advised, especially in younger women. But I would definitely not just "wait out" moderate dysplasia.

However, waiting that long is almost definitely fine. I got the same result as you a couple of years ago, and my health center had to refer me to a doctor. That appointment was nearly two months after my original pap smear. After getting the colposcopy, I had to make an appointment for a LEEP, which was one month later.

I was originally concerned about the time span, like you, but everyone I talked to assured me that months were not going to harm me.

--Ms. DeucesHigh
posted by DeucesHigh at 10:36 AM on March 2, 2009

My sister waited last year (on my and metafilter's advice) and she cleared up and didn't need the LEEP after all. You might resolve, like she did or you might not, but you won't all of a sudden have a huge spread of cancer because that's not the way HPV and displaysia work.

This is a slowly progressing thing, so waiting won't hurt much and it is important to trust and not dislike the doctor who could be cutting you up.
posted by rmless at 10:38 AM on March 2, 2009

I had a sketchy GYN in my early 20s, and ended up having an unnecessary procedure. Not saying that is the case with you, but...wait and see the new doc. A month is not so long, really, but call the (new doc's) office and explain your situation, and that you feel really concerned; they may be able to get you in sooner since physicians usually keep emergency appointments on their schedules.
posted by delladlux at 10:39 AM on March 2, 2009 [1 favorite]

Having had this procedure done by a doctor who was also cold and uncaring, I would say wait.
posted by Evangeline at 10:42 AM on March 2, 2009

You may also want to check with the new doctor's office in about a week, and see if an opening in the schedule becomes available.

Explain to the nurse or receptionist that you are looking for a 2nd opinion on a biopsy, and they may put you on "stand-by" to move you up in the schedule if something opens up.
posted by lootie777 at 11:08 AM on March 2, 2009

I was in the same situation and switched doctors. I ended up having to wait over 6 months between the time of the diagnosis to the LEEP procedure due to previously undiagnosed high blood pressure discovered at my pre-procedure physical. I had mild dysplasia, not moderate, but the LEEP came back totally fine with no abnormalities.

I'd do as lootie777 suggested and try back with the new doctor to squeeze in for a new appointment, or see if you can speak with the new doctor about your concerns. Have all of your medical records sent to the new doctor ahead of time so that when you have the new appointment she has all the information from your old doctor. That will make things go more smoothly at the new place and you can probably get in for the LEEP faster.
posted by bedhead at 11:40 AM on March 2, 2009

Why limit things to just these two doctors? Since this is a matter of some urgency I'd be shopping in an ever-widening circle away from home until I found a clinic that was more expeditious about their scheduling. An obgyn with good reputation and good bedside manner can always come later (or can be worked on in the meantime).
posted by crapmatic at 11:49 AM on March 2, 2009

I recently went through something similar but fortunately didn't need the procedure in the end. IANAD, etc, but from my reasonably extensive internet research I would say you will be fine to wait for a month to have the appointment with the new obgyn, even with moderate dysplasia. (If it helps, I would have done the same in your position, but I was lucky to have a very lovely and caring gyno and nurse who went out of their way to make sure that I understood what was going on and felt as comfortable as possible during the biopsy.)

Also, it's of vital importance to feel comfortable with any doctor who performs a procedure which can be painful and certainly makes you feel very vulnerable. Further, you need to have a doctor you can trust. Waiting a month for the appointment with the new gyno won't cause an issue, and you can then ask her about your concerns about waiting even longer for the LEEP. She will then be able to reassure you or refer you as necessary.

I know it's lame to say, "Don't be scared", as I know how much the mind runs wild about things like this. I didn't realise how stressed I was about the whole thing until it was all over. But bear in mind that it's a very slow process and there is plenty of time to take care of the problem before it even gets close to progressing to cancer. (Again, IANAD.)

This link helped me a lot when I was worried - it reminds you that what is going on is a very early warning that something may go wrong in the future if it's not dealt with. But another month is almost certainly not going to make any difference.
posted by different at 2:40 PM on March 2, 2009

Moderate cervical dysplasia (outdated terminology btw) is a high grade lesion (high grade squamous intraepithelial lesion, HGSIL). The clearance rates quoted upthread for LGSIL do not apply for higher grade lesions.

Educate yourself. The guidelines below are the same as the ones your obgyn will likely be following:

American Society for Colposcopy and Cervical Pathology

This page provides links (free) their most recent practice guidelines (first link) and a treatment algorithm (second link)

Please be aware in your readings that having a tissue/histologic (biopsy) diagnosis is much different than the cytologic (pap) diagnosis. Keep that in mind as you read different sources.

Print them out and take them to your appointment and have your provider walk you through their decision tree.
posted by i_am_a_Jedi at 3:47 PM on March 2, 2009

so while i have a "mild" case of dysplasia and my doctor did not ask me to have a LEEP procedure done after the biopsy came back, i also think you can probably wait for the second opinion. because of the fact that it is considered mild, i only have to go back for paps every six months until it clears up (2 normal ones in a row) or something changes drastically. plus, others were right to say that having such personal procedures done by a doctor you don't like can make everything far worse.

if you are very nervous about it, you should try to get in with a doctor that can see you sooner. do you have a GP who can recommend someone for you?
posted by itsacover at 11:04 PM on March 2, 2009

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