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Am Fam Physician. 2002;66(7):1316-1318

The loop electrosurgical excision procedure (LEEP) has become the most popular treatment for cervical intraepithelial neoplasia. Although intraoperative bleeding usually is controlled adequately by diathermy, postoperative bleeding is unpredictable and can be severe. Paraskevaidis and colleagues examined the role of menstrual cycle phases in bleeding associated with LEEP.

They studied women who were referred to a university clinic after either one screening test suggested high-grade squamous intraepithelial lesions or two consecutive tests suggested low-grade squamous intraepithelial lesions or atypical squamous cells of undetermined significance. Women with severe menstrual abnormalities or coagulopathies were not eligible for the study. The women were randomly assigned to undergo LEEP between days 4 and 6 of the menstrual cycle (follicular phase) or between days 16 and 18 (luteal phase). All patients were asked to record vaginal bleeding, pain, and anxiety levels daily for three months following the procedure. One gynecologist performed all of the procedures using a standard technique and assessed intraoperative bleeding.

The groups were comparable before surgery, and 30 women in each group completed the trial. The colposcopist judged intraoperative bleeding as moderate to severe in 13 percent of the follicular group and 40 percent of the luteal group. The hematocrit decrease associated with LEEP was significantly greater in women treated during the luteal phase, and these women reported significantly more days of heavy or moderate postoperative bleeding. Forty percent of women in the luteal group reported anxiety after LEEP, compared with only 10 percent in the follicular group.

The authors conclude that women who underwent LEEP during the luteal phase of the menstrual cycle experienced significantly more intraoperative and postoperative bleeding than women whose procedures took place during the follicular phase. This bleeding led to greater anxiety and more consultations with physicians. The researchers speculate that cervical blood vessels might be more reactive early in the menstrual cycle and better able to provide hemostasis during and following LEEP. They recommend that LEEP be scheduled during the follicular phase of the menstrual cycle when possible.

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