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Bleeding After Loop Electrosurgical Excision Procedure Performed in Either the Follicular or Luteal Phase of the Menstrual Cycle: A Randomized Trial

From the Department of Obstetrics and Gynecology, Ioannina University Hospital, Ioannina, Greece; and the Academic Unit of Obstetrics and Gynaecology, St. Mary’s Hospital, Manchester, United Kingdom.

Address reprint requests to: Evangelos Paraskevaidis, MD, Department of Gynecology, Ioannina University Hospital, 45001 Ioannina, Greece; E-mail: vangelispar{at}hotmail.com.

OBJECTIVE: To estimate the perioperative or postoperative bleeding rates after treatment of cervical intraepithelial neoplasia by loop electrosurgical excision procedure in either the follicular or luteal phase of the menstrual cycle.

METHODS: A randomized controlled trial was carried out to compare the outcomes in terms of primary and secondary hemorrhage between patients treated by loop electro-surgical excision procedure during either the follicular (30 women) or luteal phase (30 women) of the menstrual cycle. The two groups did not differ in terms of mean age, grade of cervical intraepithelial neoplasia, depth of excision, parity, and duration of menses. Primary outcome measures included the objective and subjective assessment of intra-operative and postoperative bleeding.

RESULTS: Women treated during the luteal phase of the menstrual cycle experienced significantly more postoperative bleeding than women treated during the follicular phase, as assessed by the fall in hematocrit levels (P < .001) and subjective reports. Intraoperative bleeding was judged to be more severe in women treated during the luteal phase of the cycle by a single, blinded colposcopist (P = .02). These women also experienced higher levels of anxiety postoperatively, which resulted in more consultations with medical staff (P = .007).

CONCLUSION: The use of loop electrosurgical excision procedure to treat cervical intraepithelial neoplasia results in less bleeding if performed during the follicular phase of the menstrual cycle.