• Reference Number: HEY-1377-2023
• Departments: Gynaecology
• Last Updated: 3 April 2023

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the Colposcopy Healthcare Team.

This leaflet will provide you with the information that you need about conservative management following a diagnosis of Cervical Intraepithelial Neoplasia Grade 2 (CIN 2). It is important to remember that CIN 2 is not cancer but is a change in the cells of the cervix (neck of the womb) requiring either treatment or conservative management (surveillance) to ensure that cancer does not develop in the future. Your Doctor or Nurse Colposcopist will discuss the options with you and recommend the best approach based upon your wishes

What is Cervical Intraepithelial Neoplasia Grade 2 (CIN 2)?

It is important for you to know that CIN is not cervical cancer. CIN may be monitored or treated, depending on the grade and your personal situation.

The cervix is lined by cells called squamous cells. These cells are on the outside of the cervix and come into contact with the environment inside the vagina. The Human Papilloma Virus (HPV) is a very common virus with more than one hundred different subtypes. Some of these subtypes can cause changes to the squamous cells of the cervix. If the cells undergo change and become abnormal this can lead to pre-cancerous cells or Cervical Intraepithelial Neoplasia (CIN). CIN is graded from 1 to 3. The number shows how deep the cell changes go into the outer surface of the cervix. Sometimes, the terms low grade or high grade are also used.

Grade 2 means that these abnormal cells could have the potential to develop into cancer if they are not treated or they can spontaneously go back to normal without treatment.

Will cell changes develop into cervical cancer?

With the right management, the risk of cell changes developing into cervical cancer is low. Most cell changes do not develop into cervical cancer.

Because most cases of CIN 3 and CGIN (Cervical Glandular Intraepithelial Neoplasia) are treated, we don’t have much data on how likely they are to progress into cervical cancer or regress back to ‘normal’ cells. The numbers given in the table below are estimates and based on the best studies we currently have.

The likelihood of progression or regression depends on your personal situation, including factors like:

• age
• grade of CIN
• whether or not you smoke
• whether you have a condition that affects your immune system.

What are the Treatment Options for CIN 2?

Large Loop Excision of the Transformation Zone (LLETZ). This is a common treatment to remove abnormal cells from the cervix. It is usually performed in the colposcopy clinic with a local anaesthetic. It is a small procedure to remove a small area of skin (loop) from the cervix and uses an electric current to remove the abnormal cells from the cervix.

The benefit of this treatment is that it removes the abnormal cells from the cervix and allows normal cells to grow back in their place.

The main complications following this treatment can be potential heavy vaginal bleeding and vaginal infection.

This LLETZ treatment can create a potential risk of having a premature birth in women who have not yet had any children or wish for a further future pregnancy. Removal of the abnormal cells (CIN) can potentially weaken and shorten the cervix. The risk is usually determined by the amount of cervix removed during the treatment. The Doctor or Nurse Colposcopist will discuss this with you when discussing the treatment options. The LLETZ treatment is not associated with any increased risk of infertility.

Conservative Management

Current health guidelines on monitoring CIN 2 says it can be offered if:

• colposcopy has shown CIN 3 or cervical cancer is not present.
• the CIN 2 is in less than half of the cervix.
• a group of doctors and nurses (multidisciplinary team or MDT) have talked about your situation and agreed on recommendations.
• you are comfortable with the monitoring plan, including understanding that CIN 2 can sometimes take 2 years to regress .

You will be invited for a monitoring appointment 6 months after your initial colposcopy. This will be at the colposcopy department in the hospital. It will usually involve a visual colposcopy examination and a biopsy, just like your original colposcopy appointment. You may also have a cervical screening (smear) test. Following your biopsy and cervical screening test results, in summary:

• If the CIN 2 is gone or has regressed:  What happens next will depend on your exact result. Your colposcopy team will let you know what other appointments you need.
• If the CIN 2 has stayed the same: You will be invited back to colposcopy in 6 months.
• If the CIN 2 has progressed: CIN 2 may progress to CIN 3. If this happens, your colposcopy team will offer you LLETZ treatment.

If CIN 2 has stayed the same for 2 years, your colposcopy team will offer you LLETZ treatment. It is important you feel comfortable and involved in any decisions, so try to ask all the questions you need.

Is conservative management a suitable option for me?

This treatment option is beginning to be offered as studies have shown that in time, CIN 2 can return to normal in approximately 50% of women who have no treatment, and in up to 60% of women who are less than 30 years old. This is important because of the risks associated with LLETZ treatments. In more recent years, studies have also shown that conservative management does not have a significant effect upon a woman’s reproductive health. In women who have not yet had any children, or wish for a further future pregnancy, conservative management can potentially avoid the risk of preterm labour.

Conservative management of CIN 2 will depend on your individual circumstances. The Colposcopy Specialist Team will discuss the options with you and make a recommendation based on your individual circumstances. If you are in a younger age group, have not had any children or wish to have a future pregnancy then conservative management is a treatment option worth considering.

What does conservative management involve?

You will be seen in the colposcopy clinic at 6 monthly intervals where you will have a colposcopy examination, a cervical screening test and possibly a cervical biopsy. You will be seen every 6 months until your cervical cells return to normal. You will then be discharged from the colposcopy clinic and your cervical screening tests will be performed by your GP as part of the routine NHS Cervical Screening Programme. If at any point your CIN2 progresses to a higher grade (CIN 3) we will recommend a LLETZ  treatment. If after 2 years of close observation the CIN 2 remains, then we will re-discuss your options and likely recommend a LLETZ treatment. It is very important that you attend the colposcopy clinic for your appointments. If you feel that you are not able to attend the colposcopy clinic at 6 monthly intervals then conservative management is not an appropriate treatment for you and we would recommend that you have a LLETZ treatment.

What are the benefits and risks of Conservative Management?

Less than 1 in 200 women with CIN 2 will develop cervical cancer in a 2 year conservative management period. 1 in 5 women with conservatively managed CIN 2 will progress to a higher grade of CIN within 2 years, but at this time they will be offered a LLETZ. About 50% of the cases of CIN2 will go back to normal without treatment.

Your colposcopy team should talk through all options for managing cell changes with you, including monitoring or treating. As part of that conversation, they should explain the risks and benefits of the different options.

The benefits of monitoring:

• You do not have to have treatment. This means you avoid any physical or emotional impacts of treatment that some people experience.

The possible risks of monitoring:

• Cell changes may progress to a higher grade. Going to regular monitoring appointments helps to reduce this risk.
• You have to go to more GP or colposcopy appointments. We know that, for some people, this can be difficult or distressing.

What if I change my mind about Conservative Management?

You can change your mind at any time during the surveillance. You can contact the colposcopy clinic if you are feeling worried or concerned about your treatment and speak to a member of the Colposcopy Specialist Team.

 It is important to understand the benefits and risks of any options for managing cell changes, and that you feel comfortable with your decision. 

Who can I contact if I have any questions? If you need any further information please do not hesitate to contact us on:

Colposcopy Nursing Team: (01482) 382644.

Colposcopy Clinic (01482)607829.

Colposcopy Secretaries: (01482)624035/624031.

Useful Contacts / Information

The British Society for Colposcopy and Cervical Pathology:  www.bsccp.org.uk

Jo’s Cervical Cancer Trust:  https://www.jostrust.org.uk

This leaflet was produced by the Colposcopy Services, Gynaecology Department, Hull University Teaching Hospitals NHS Trust and will be reviewed in April 2026.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.