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LLETZ and Future Pregnancy: What Every Woman Deserves to Know
- thesmartdoula
- Jun 23
- 8 min read
Updated: Jun 24
If you've had a LLETZ procedure or have just been told you need one, you may be wondering what it could mean for future pregnancies (or maybe no one has told you that you should even think about this!).
For many women, this is information they only discover when they become pregnant. Others are fully informed beforehand and are able to access appropriate monitoring and support.
This blog isn't about frightening women away from treatment. LLETZ can be an important procedure that helps prevent cervical cancer.
It is about ensuring women have access to balanced information so they can make informed decisions and advocate for themselves in future pregnancies.
The two women I quote in this blog, who have kindly shared their stories, had the same procedure but two different experiences.
What is a LLETZ Procedure?
LLETZ stands for Large Loop Excision of the Transformation Zone.
It is a treatment used to remove abnormal cells from the cervix. These changes are usually identified following cervical screening and colposcopy. The aim is to prevent abnormal cells from developing into cervical cancer.
The procedure is commonly performed under local anaesthetic and uses a thin wire loop to remove the affected area of cervical tissue.
For many women, LLETZ is an effective treatment with significant benefits. However, like all medical procedures, it is important to understand both the benefits and the potential risks.
For Carla, abnormal cells were first identified during pregnancy and persisted after her baby was born, until eventually a LLETZ was suggested.
Katie's second smear test showed borderline abnormal cells. She had a test every 6 months until finally it was confirmed that the cells were now abnormal, and she was advised to have a LLETZ procedure.
The Importance of Informed Consent in LLETZ and Future Pregnancy
When making decisions about healthcare, consent should be based on a clear understanding of both the potential benefits and the possible risks.
The Royal College of Obstetricians and Gynaecologists lists an increased risk of late miscarriage and premature birth as recognised risks following LLETZ.
While most women will go on to have healthy pregnancies, these potential implications are important considerations for anyone hoping to have children in the future.
Many women would still choose treatment even after hearing these risks. The issue is not whether women should have the procedure (although, of course, this is their choice). The issue is whether they are given the information needed to make a fully informed choice and to seek appropriate support in future pregnancies.
Katie was made aware of the potential need for a 'stitch' in future pregnancies when she was being discharged after the procedure, whilst Carla doesn't remember ever being told of these risks.
"I Wasn't Told..." LLETZ and Future Pregnancy
'I didn't really know what they were doing, really, I was just going with it, at that point, I'd just had George, I didn't even really know if I wanted more children, and that wasn't discussed' - Carla
This experience highlights why informed consent matters.
For some women, the greatest difficulty is not the procedure itself. It is discovered years later that a previous treatment may be affecting a pregnancy, without ever having been told this was a possibility.
What Does the Evidence Say About Pregnancy After LLETZ?
The reassuring news is that current evidence suggests LLETZ does not appear to reduce fertility. Most women can conceive without difficulty following treatment.
However, research has identified associations between cervical treatment and certain pregnancy complications.
Studies suggest that women who have undergone cervical excisional treatments may have an increased risk of:
Cervical shortening
Cervical insufficiency
Second-trimester pregnancy loss
Preterm birth
The exact level of risk varies between studies and is influenced by factors such as how much cervical tissue was removed and whether a woman has undergone multiple procedures.
RCOG States that:
About 2 in 100 (2%) people who become pregnant at any time after LLETZ will give birth before 37 weeks (prematurely) because of the treatment. About 98 in 100 (98%) people will not give birth prematurely because of the treatment.
The cervix plays an important role during pregnancy. It helps keep the pregnancy safely inside the uterus until labour begins. When a significant amount of cervical tissue has been removed, there may be less structural support available during a future pregnancy.
It is important to remember that increased risk does not mean complications are inevitable. Most women who have had a LLETZ procedure will still go on to have healthy pregnancies and healthy babies.
RCOG mentions that:
Giving birth prematurely is more likely if you have had LLETZ more than once or had more than 10mm of your cervix removed. Most LLETZ treatments remove less than 10mm of your cervix.
Both Carla and Katie describe having large amounts of their cervix removed.
Carla describes seeing the excised piece of her cervix after the procedure and asking what it was, being told that it was 'her cervix' and that it was going off for testing.
Katie's surgeon ran after her once she was discharged and said she was sorry she had to remove much more than was expected (14mm).
Why Some Women Need Extra Monitoring in Pregnancy after a LLETZ Procedure
Because of the potential impact on cervical length, some women may be offered additional surveillance during pregnancy.
This may include:
Transvaginal cervical length scans
Referral to a preterm birth clinic
Consultant review
Progesterone treatment, where appropriate
Cervical cerclage (a stitch placed around the cervix) in some circumstances
The type of monitoring offered depends on an individual's history and current pregnancy.
Early identification of cervical shortening can allow healthcare professionals to discuss available options and develop a personalised care plan.
Knowledge Can Change the Experience
Being aware of potential risks does not mean expecting complications.
In fact, understanding the implications of a previous LLETZ procedure can allow women to access appropriate monitoring and support much earlier in pregnancy.
'When I went for my booking appointment at 10 weeks, I told the midwife I needed to have a stitch put in because of having the LLETZ procedure'
'Early second trimester, I would go for a scan to check the cervix length every couple of weeks. The appointments were very regular, but I didn't mind....... then at 21 weeks my cervix suddenly shortened, and it was time for a stitch to be put in' - Katie
This experience demonstrates the difference that information can make.
Knowing about potential risks allows women to ask questions, seek monitoring and make informed decisions throughout their pregnancy.
'I had miscarriage after miscarriage and then finally became pregnant with Olivia, but I had bleeding, when they measured my cervix, because I had had so many miscarriages, they were like - it's too short to carry, there is no way you will be able to carry this pregnancy without a stitch' - Carla
Carla's experience demonstrates how the lack of information can mean that, rather than feeling calm and supported, like Katie, the need for intervention can be urgent and come as a shock.
A Cervical Stitch for a Shortening Cervix after LLETZ
A cervical stitch, also known as a cervical cerclage, is a procedure used to help support the cervix during pregnancy when there is concern that it may shorten or open too early.
The procedure involves placing a strong stitch around the cervix, usually through the vagina, to help keep it closed as the pregnancy progresses.
It is typically performed in a hospital under either a spinal, epidural or general anaesthetic.
A cerclage may be offered to women with a history of cervical insufficiency, previous second-trimester losses, or evidence that the cervix is shortening during pregnancy.
The stitch is usually removed at around 36 to 37 weeks of pregnancy, allowing labour to begin naturally if that is the plan.
Not everyone who has had a LLETZ procedure will need a cervical stitch. Many women will simply be offered monitoring of their cervical length during pregnancy. If shortening is detected, healthcare professionals can then discuss whether treatments such as progesterone or cerclage may be appropriate.
'The procedure was nothing to worry about. Other than being really hungry because you couldn't eat before the spinal! And whilst it was only meant to take 20 minutes, my body is very unique, never does anything the way it should do, so it took one and a half hours. The team in the room were lovely, and I felt very cared for. The major downside after it, and apologies if this is TMI .....is that you aren't allowed to have sex after it!'
'I was told to have the stitch taken out at 37 weeks, which I did. And advised to take my hospital bag with me just in case! But labour didn't start, and after that I went home. - Katie
In some cases, particularly where a large amount of cervical tissue has previously been removed, placing a stitch may be technically difficult or not possible. This is why early discussion and monitoring can be so important for women who have undergone cervical treatment - unfortunately, this was Carla's experience.
After being told at her scan that she needed a stitch, or she would not be able to carry this baby. She was asked to return the next day for surgery, and after waiting for the full day....
'I lay on the table at 5 past 6, and the surgeon I was supposed to be seeing had gone, the guy/surgeon came in, I'd had my spinal and everything... he said, I can't do the stitch, you've got no cervix left to stitch, I'm really sorry. He said if I do this stitch, I'm going to burst your babies' amniotic sack, and I'm not prepared to do that, or even try to do it' - Carla
Carla went home after being told that next time they try, she needed to come in to get the stitch higher up earlier. She was told to hope for the best at 21 weeks; there was no hospital nearby that could save a baby that was that premature.
She lay down for 19 weeks, took the pressure off her cervix, and thankfully, her baby was born at 39 weeks.
What Should You Do If You've Had a LLETZ Procedure?
If you are pregnant and have previously undergone a LLETZ procedure, it is worth discussing this with your midwife or obstetrician early in pregnancy.
You may wish to ask:
Does my history mean I should have cervical length monitoring?
Am I eligible for referral to a preterm birth clinic?
What symptoms should I be aware of?
What options are available if cervical shortening is identified?
Every situation is unique, and recommendations should always be individualised.
Final Thoughts
LLETZ is an important treatment that helps prevent cervical cancer and protects women's health.
At the same time, women deserve to understand how treatment today may influence pregnancy tomorrow.
For some women, that knowledge changes very little. For others, it may influence the monitoring and support they receive during pregnancy.
Most importantly, informed consent allows women to make decisions with their eyes open.
Whether you are considering a LLETZ procedure, have already had one, or are currently pregnant after treatment, understanding the evidence can help you navigate the path ahead with confidence.
Who am I?
I am Charlotte, a Virtual Doula, providing bespoke evidence-based pregnancy support to families who want an empowering birth.
With 10 years + of clinical research experience, a biomedical science degree, and two hospital births under my belt, I use my knowledge to provide pregnancy support to help you make informed decisions about your pregnancy, birth, and postpartum.
I provide pregnancy support for all types of births, including hospital births, helping you to navigate NHS guidelines and have an empowering, positive birth.
Who is Carla?
Carla is the founder of mybump2baby - one of the UKs leading parenting platforms.
Carla is passionate about connecting small business owners and parents together and supports small business owners in the parenting industry with systems and marketing strategy
Who is Katie?
Katie is a Naturopath and Postnatal Doula who supports families from pregnancy through early parenthood and beyond. She combines evidence-informed natural healthcare with practical postnatal support, helping clients improve their health, navigate the challenges of new parenthood and feel more confident in their choices. Katie's warm, non-judgmental approach focuses on supporting the whole person, not just the symptoms, creating personalised plans that fit real family life.
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