Cervical screening is a preventive health test designed to detect changes to the cells of the cervix before they develop into cervical cancer. In Australia, the National Cervical Screening Program recommends that women and people with a cervix aged between 25 and 74 who have ever been sexually active have a cervical screening test every five years.
The test involves collecting a small sample of cells from the cervix, which is then tested for the human papillomavirus (HPV). HPV is a very common virus, and most people who are sexually active will encounter it at some point in their lives. In the majority of cases, the immune system clears the virus on its own without any treatment. However, certain strains of HPV, if they persist over time, can cause changes to cervical cells that – if left undetected and untreated – may
An abnormal result means that either HPV was detected in the sample, or that some changes to the cervical cells were found, or both. The way these results are interpreted, and what happens next, depends on which specific findings were reported.
Cervical cell changes are usually described in terms of how significant they appear:
These are minor cellular changes that are often temporary and may clear on their own without any intervention, particularly in younger women. Low-grade changes are very common and frequently reflect a recent, transient HPV infection rather than a lasting problem.
More significant cellular changes that are less likely to resolve without treatment and are more closely associated with a risk of future cervical cancer if left unaddressed. High-grade changes still don’t mean cancer is present; they mean the cells need to be assessed and treated promptly to prevent potential progression.
In either case, further investigation is usually recommended, and a colposcopy is the most common next step.
A colposcopy is a more detailed examination of the cervix, performed in a clinic setting. A speculum is used to widen the cervical opening, and a magnifying instrument called a colposcope is used to give a detailed view of the cervix. The colposcope is positioned just outside the cervix. A solution may be applied to the cervix to highlight any areas of abnormal tissue more clearly.
If any areas look concerning during the colposcopy, a small tissue biopsy may be taken and sent to the laboratory for analysis. This gives a clear picture of whether any abnormal cells are present, how significant they are, and what treatment, if any, is recommended.
Most women find a colposcopy no more uncomfortable than the original cervical screening test, and the procedure is generally completed within 15 to 20 minutes.
Not every abnormal result requires immediate treatment. For low-grade changes, particularly where there’s no high-risk HPV present, watchful waiting with a repeat test or colposcopy after a set period may be entirely appropriate. Many of these mild abnormalities will self-resolve without intervention.
For high-grade changes, treatment is usually recommended to remove or destroy the affected cells before they have the opportunity to progress further. There are several ways this can be achieved, and the most appropriate approach depends on the extent of the changes, the results of your colposcopy and any biopsy taken, your individual circumstances, and your future fertility plans.
LLETZ (large loop excision of the transformation zone) is the most commonly used treatment for high-grade cervical cell changes in Australia, and is generally the preferred first-line approach. It involves using a small, thin wire loop heated by an electrical current to precisely remove the layer of tissue on the cervix where the abnormal cells are located. The procedure is typically performed under local anaesthetic in a clinic or under general anaesthetic, depending on individual circumstances and preferences.
The removed tissue is sent to the laboratory for analysis, meaning it serves as both a treatment and a diagnostic tool, confirming the extent and nature of the abnormality once it has been removed. The procedure is generally quick, and most women recover and return to normal activities within a few days, although some light bleeding or discharge in the days following is normal.
Where LLETZ isn’t the most suitable approach, there are several alternatives that Dr Mandana may discuss with you:
Dr Mandana will explain clearly which approach is most appropriate for your specific situation and why, so you can make an informed decision about your care. For women planning future pregnancies, this is particularly worth discussing before any procedure, as the amount of cervical tissue involved can vary between approaches.
You deserve a gynaecologist who listens carefully, explains things clearly, and treats your concerns with evidence-based, patient-centred management strategies. Get in touch with Dr Mandana Master at Embrace Fertility today to arrange a consultation.
