Abnormal smear test results and colposcopy

Cervical screening aims to detect early cell changes that could develop into cervical cancer if left untreated. An abnormal smear test result does not mean cancer is present, but it does indicate changes that need further assessment. Colposcopy is the standard procedure used to examine the cervix in more detail. This article explains what abnormal smear results mean, why colposcopy is recommended, and what to expect from the procedure.

What does an abnormal smear test result mean?

A smear test checks for high-risk human papillomavirus (HPV) and cell changes on the cervix. Most abnormal results relate to HPV, a common infection that usually clears on its own. When HPV persists, it can cause cell abnormalities that require monitoring or treatment.

Abnormal results may include:

• HPV positive with normal cells
• Low-grade cell changes
• High-grade cell changes

These results indicate the level of risk, not the presence of cancer. High-grade changes are still precancerous and are very treatable.

Why is colposcopy recommended after an abnormal result?

A colposcopy provides a clearer view of the cervix than a standard smear test. It allows the specialist to identify the exact area of abnormal cells, determine how significant the changes are, and decide whether treatment is needed.

Colposcopy is usually recommended if:

• HPV is present on two consecutive screening tests
• Cell abnormalities are detected
• The smear test sample was unclear and needs repeating with closer examination

This approach helps ensure that early changes are treated before they develop further.

What happens during a colposcopy?

A colposcopy is similar to having a smear test. The specialist gently inserts a speculum and examines the cervix using a colposcope, a magnifying device that stays outside the body. They apply a mild solution to highlight abnormal cells.

The appointment typically involves:

• Examination of the cervix: The colposcope magnifies the tissue to show any areas of concern.
• Biopsy if needed: A small sample is taken from the cervix to confirm the type and severity of cell changes. This may feel like a brief pinch.
• Immediate treatment in some cases: If high-grade changes are identified, a treatment such as LLETZ (large loop excision of the transformation zone) may be offered during the same appointment.

Most people can return to normal activities straight afterwards, although light spotting may occur after a biopsy.

What treatments are available if abnormal cells are confirmed?

If the biopsy confirms high-grade changes, treatment aims to remove or destroy the affected tissue. The most common treatment is LLETZ, which uses a thin wire loop to remove the abnormal area. This is usually done under local anaesthetic and takes only a few minutes.

Other treatments may include:

• Cold coagulation (heat treatment)
• Cone biopsy (for larger or deeper areas of abnormal change)

These treatments are highly effective, and most people need no further intervention after regular follow-up.

When should you seek medical advice?

Anyone who receives an abnormal smear result will be contacted automatically with instructions for follow-up. However, you should seek advice sooner if you experience symptoms such as persistent bleeding after sex, abnormal discharge, or bleeding between periods.

Colposcopy is a straightforward and important step in preventing cervical cancer. Early assessment and treatment offer excellent outcomes and provide reassurance for those concerned about abnormal screening results.