title: After-effects reported by women following colposcopy, cervical biopsies and LLETZ: results from the TOMBOLA trial.
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).
  
  
  METHODS
  Observational study nested within a randomised controlled trial.
  
  
  METHODS
  Grampian, Tayside and Nottingham.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors: Linda
authors: L
authors: Sharp
authors: Seonaidh
authors: S
authors: Cotton
authors: Claire
authors: C
authors: Cochran
authors: Nicola
authors: N
authors: Gray
authors: Julian
authors: J
authors: Little
authors: Keith
authors: K
authors: Neal
authors: Maggie
authors: M
authors: Cruickshank
mesh_terms: D000328:Adult; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery; D003127:Colposcopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008598:Menstruation; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D016896:Treatment Outcome; D006113:United Kingdom; D014592:Uterine Hemorrhage / Q000209:etiology*; D019522:Vaginal Discharge / Q000209:etiology*; D055815:Young Adult