If you've learned you have abnormal cervical cells following your smear test, the first thing to know is that they're common, they often improve by themselves and they're normally nothing to worry about. But sometimes, these cell changes need to be addressed to prevent them from becoming anything more serious. Left untreated, there's a risk they can develop into cervical cancer. The tricky part is that abnormal cervical cells don't display symptoms. You won't know you have them unless you get a cervical screening – which is why your smear test is essential.
I was almost five years late to my first smear test, so when my results flagged abnormal cervical cells, I felt responsible. Or rather, I felt enormously irresponsible. I write about the importance of smear tests as part of my job in beauty and health. I know how important they are. I've said so here.
The worst part is that I have no explanation for the delay other than life getting in the way. I moved house, focused on work deadlines, then Covid happened. After that, I moved again (away from my doctors). I'd been meaning to go, I meant to book in, but I didn't get round to it. By the time I finally signed up to a new doctor I felt huge anxiety about going to my cervical screening. What excuse did I have for failing to prioritise my health when it's one of the most precious things I have? I'd taken my good health for granted, gambling that all was well because I was young, felt fine and had really meant to book it in asap.
After I attended my smear test, I put it out of my mind, until I got a letter through the door with my results.
Getting my results
My results showed that I had changes to some of the cells in my cervix called “low-grade dyskaryosis". The letter informed me that “in almost all cases these abnormal cells are not found to be cancer,” but they wanted me to come in for further examination.
Because I was so late in attending my smear I felt a huge amount of guilt and worry that, were something to be detected, I'd delayed my own treatment. The only way around this is to make sure you take your smear tests seriously, and attend them promptly so any abnormalities can be dealt with swiftly – so this felt like a wake-up call. Those cells could have been years old, but equally they may have only recently developed. The best way to investigate whether they were cause for concern was with a colposcopy. My letter invited me to attend the procedure and included a separate letter with details of my appointment.
I was sent for a colposcopy
Not to be confused with a colonoscopy (which sees a camera inserted into your rectum), a colposcopy allows for your gynaecologist to see what's happening inside your cervix. You'll have to strip down from the waist and sit back in a chair, with your feet lifted into stirrups on either side. A speculum is inserted into your vagina to open it (the same as in a smear), then a microscope camera is placed in front of, but not inside of, your vagina to give a clear image of your cervix. An acetic acid or iodine solution is applied over the cervix which helps to identify abnormal cells by turning them white. This helps to show the following:
According to the NHS, about 4 in 10 people who have a colposcopy will have a normal result, which means that your cervix looks healthy and you have a low-risk of developing cervical cancer before your next screening. You can have a normal colposcopy result even if you had an abnormal result during your cervical screening.
About 6 in 10 people will have abnormal cells, or CIN (cervical intraepithelial neoplasia), found. CIN is not cancer, but it can sometimes go on to develop into cancer. The colposcopy and biopsy results will show whether these cells need to be removed or can be left alone. This will depend on whether your CIN is “low grade” or “high grade”.
CIN 1
CIN 1 (low grade) means you're unlikely to develop cervical cancer and often the abnormal cells will go away on their own. You'll likely be invited back for another smear in 12 months to check up.
CIN 2
CIN 2 or 3 (high grade) mean you have a higher chance of developing cervical cancer than CIN 1. You will normally be offered treatment to remove the abnormal cells which lower the risk of developing cervical cancer.
Cervical cancer
In rare cases, cervical cancer can be found – if this happens, you'll be referred to a team of specialists. Cancer diagnosed through screenings are usually found at an earlier stage, and the earlier it's found the better your chance of treating and beating it.
While the examination is taking place, a screen above the bed shows you and your gynaecologist what's going on with your cervix, but you can choose not to look. My doctor guided me around my cervix and directed my attention to a tiny smattering of white cells. They could well clear up on their own, he told me, but, they could also become worse – and if that happened, I might need treatment to remove them.
The gynaecologist took a biopsy
To be sure the cells were nothing to worry about, my gynaecologist decided to take a biopsy (a small sample of tissue from my cervix) for laboratory analysis. For me, the worst part – apologies if you're squeamish – was watching the screen while the biopsy was taken. I watched a tiny pair of forceps go in, clamp down on a small section of my cervix and remove it. I felt it too. A painful, pinching, cramping sensation that made me want to convulse and slam my legs shut. It caused some bleeding, which was stemmed using a stick that cauterised the wound closed. It wasn't the most comfortable procedure, admittedly, but it was quick. After that, I was able to release my legs from the stirrups and get dressed. I was advised not to use a tampon while my cervix healed, as this can lead to infection – and I had one evening of very painful cramping before things eased back to normal. It was uncomfortable and unpleasant, yes, but it's better than the alternative – not investigating whether there's a problem until it's too late. If you're worried about the procedure, I recommend telling the doctor about your anxiety – you can always look away from the screen, too. You can also opt to undergo your colposcopy under anaesthetic, if you would prefer.
In some cases, if your doctor sees cells they think need immediate removal, they can offer you treatment on the day. A local anaesthetic is applied to the cervix and the area of abnormal cells is removed using a procedure called loop excision which uses a heated wire to remove abnormal cell tissue (usually around the size of a fingernail), but this wasn't deemed necessary for me.
I waited for the results
My gynaecologist made me feel calmer. He predicted the abnormal cells would go away on their own, but he told me to wait for a letter with the results of my biopsy (which can take up to 8 weeks). He said the most likely outcome was that the letter would ask me to come back in a year's time to monitor whether the cells had disappeared or become worse.
The abnormal cells spread
Unfortunately, the biopsy showed that the cells had worsened to CIN 2. I was called by a nurse to deliver the results and she discussed options with me. She told me that the cells still had a good chance of disappearing on their own, or the alternative was removal (either the loop excision, known as a LLETZ, mentioned above – or a cone biopsy, performed under general anaesthetic, where the surgeon cuts out a cone shaped area of cells).
Removal, she told me, came with a small increase in the risk of future babies coming prematurely if I were to become pregnant. I didn't want to put any future babies at risk, and because I was fairly young (30) the nurse thought I'd have a good chance of my body removing the cells by itself. I was told I'd be closely monitored and booked back in for another smear in three months time.
When I had my next smear, once again, the results came back abnormal and I was sent for another biopsy – which showed the cells had spread and worsened to CIN 3 and removal was the only option.
Abnormal cell removal
Because the area of high risk abnormal cells had grown larger quickly, I was advised that they'd need to be operated on under general anaesthetic rather than local, using the LLETZ procedure.
The average length of your cervix when you're not pregnant is about 2.5cm, and surgeons are able to remove up to 1cm of cervix before it can cause problems in pregnancy. My surgeon removed 0.9cms (alongside the biopsies that had also been taken). Because of this, I was advised to let my midwife know about the operation in any future pregnancies – so I could be monitored more closely.
Post-op
I was invited in for another smear test about six month after my operation. Again, it showed abnormal cells, so I had to go in for another colposcopy. This time, the gynaecologist found that the abnormal cells were very minimal and low-risk so there was no need for a biopsy – and I was asked to return to my GP for a smear in a year's time.
Pregnancy post abnormal cell removal
About three months after my last smear, I became pregnant and I let my midwife know about the operation at my first appointment. I was booked in for a cervical examination at around 18 weeks pregnant to check on my cervix. They use a vaginal ultrasound probe (so you get an extra sneak peek of your baby) and use it to digitally measure the length of your cervix on screen. Everything looked healthy, but because so much of my cervix had been taken, I was asked in for a follow up at 22 weeks to double check. This time I was discharged as it remained in good shape.
There are steps that the hospital can take to assist your pregnancy if this is not the case. You can have a stitch put in to reinforce your cervix, or you can be prescribed progesterone (administered vaginally or rectally by yourself daily) to strengthen your cervix, and your midwife will monitor you closely.
The takeaway
There's no way of knowing how long my abnormal cells had been there and whether earlier detection could have changed anything, but I've learnt my lesson. Leaving them any longer could have completely changed my outlook. Knowledge is power and peace of mind is precious. Going forward I'll be attending my smear tests as soon as I'm invited – because early detection is the best way of combatting cervical cancer.
Please call your GP now to book in for your smear. You can read more about smear tests on the NHS website.
For more from GLAMOUR's Senior Beauty Editor, Elle Turner, follow her on Instagram @elleturneruk
