Conservative management of CIN 2 (Cervical Intraepithelial Neoplasia Grade 2)
Information for patients from Women's Health
This leaflet is for patients diagnosed with Cervical Intraepithelial Neoplasia Grade 2 (CIN 2).
It is important to remember that CIN 2 is not cancer. It is a change in the cells of the cervix (neck of the womb). CIN 2 needs either treatment or conservative management (close monitoring) to make sure that cancer does not develop in the future. Your doctor or nurse colposcopist will discuss your options with you. They will recommend the best approach based on how you want to proceed.
Conservative management means treating a condition or injury with non-invasive or non-surgical methods. This can include taking medications, doing physical therapy, and making changes to daily habits. The conservative management of CIN 2 will involved regular monitoring of your condition in the Colposcopy Clinic.
We hope this leaflet answers some of the questions you may have. If you have any further questions or concerns, please speak to a member of your healthcare team.
What is Cervical Intraepithelial Neoplasia Grade 2 (CIN 2)?
It is important for you to know that CIN is not cervical cancer. We can monitor or treat CIN, depending on the grade and your personal situation.
CIN is graded from 1 to 3. The number shows how deep the cell changes go into the outer surface of the cervix. Sometimes, we will also use the terms low grade or high grade.
CIN 1 (low grade) - up to one third of the thickness of the lining covering the cervix has abnormal cells.
CIN 2 (high grade) - up to two thirds of the thickness of the lining covering the cervix has abnormal cells.
CIN 3 (high grade) -the full thickness of the lining covering the cervix has abnormal cells.
What causes CIN?
CIN is caused by certain types of the Human Papillomavirus (HPV). HPV is an extremely common virus that spreads through sexual contact. 4 in 5 women will be infected with HPV at some point in their lives.
The two main types of HPV
Low-risk types can cause genital warts, and is not usually a risk factor for developing cervical cancer.
High-risk types can cause CIN and more uncommonly cervical cancer.
Although these viruses are common, 9 in 10 cases resolve on their own within 2 years. Therefore, most women who have the HPV virus do not develop cervical cancer.
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 do not have much data on how likely they are to progress into cervical cancer or regress (return) back to ‘normal’ cells. The numbers given in the table below are estimates and based on the best studies we currently have.
| Type and grade of cell change | Regress | Stay the same | Progress |
|---|---|---|---|
| CIN 1 | 60% | 30% | 10% (to CIN2 and CIN 3) |
| CIN 2 | 50 to 60% | 32% | 18% (to CIN 3) |
| CIN 3 | 32 to 47% | data not available | 32% to 40% |
The likelihood of progression or regression depends on your personal situation, including factors like:
age
grade of CIN
whether you smoke
whether you have a condition that affects your immune system
What are the treatment options for CIN 2?
There are two management options for CIN 2:
conservative management (regular monitoring)
LLETZ (large loop excision of transformation zone) procedure
Conservative management involves monitoring your condition every 6 months, for no more than 2 years. This may include repeat smear tests, colposcopy, and, if necessary, biopsies.
This approach is based on studies showing that CIN 2 returns to normal on its own, in approximately 5 in 10 women who do not undergo treatment. For women under 30 years of age, this rate may rise to 6 in 10. However, it can take up to 2 years for CIN 2 to resolve.
During this 2 year follow-up period, around 18 in every 100 CIN 2 cases may progress to CIN 3. If this happens we will recommend a LLETZ procedure. It is important to note that less than 1 in 100 women with untreated CIN 2 will develop cervical cancer within 2 years. If the CIN 2 does not resolve within 24 months of monitoring, we will recommend a LLETZ procedure.
What is LLETZ?
Large Loop Excision of the Transformation Zone (LLETZ) 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. LLETZ 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
vaginal infection
LLETZ treatment can also create a potential risk of having a premature birth in the future.
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 your treatment options.
LLETZ is not linked with any increased risk of infertility.
Why is conservative management offered for CIN 2?
Current health guidelines on monitoring CIN 2 say we can offer conservative management if:
colposcopy has shown CIN 3 or cervical cancer is not present
the CIN 2 is in less than half of the cervix
a team of doctors and nurses have talked about your case and agreed on recommendations
you are comfortable with the monitoring plan, including understanding that CIN 2 can sometimes take 2 years to regress.
We will invite you for a monitoring appointment 6 months after your first colposcopy. This will be at the Colposcopy Clinic. At this appointment most patients will have a colposcopy examination and a biopsy. You may also have a cervical screening (smear) test.
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: We will invite you 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 ask all the questions you need.
Is conservative management a suitable option for me?
We offer conservative management as studies have shown that in time, CIN 2 can return to normal:
in approximately 5 in 10 women who have no treatment; and
in 6 in 10 women who are less than 30 years old.
Studies have shown that conservative management does not have a significant effect upon a woman’s reproductive health.
LLETZ treatment can create a potential risk of having a premature birth in future pregnancies. Using a conservative management approach can potentially avoid this risk.
Conservative management of CIN 2 will depend on your individual circumstances. The Colposcopy team will discuss the options with you. They will make a recommendation based on your individual circumstances. Conservative management is a treatment option worth considering if you:
are in a younger age group
have not had any children
wish to have a future pregnancy
What does conservative management involve?
You will have an appointment at the Colposcopy clinic every 6 months, until your cervical cells return to normal.
At these appointments you will have:
a colposcopy examination
a cervical screening (smear) test
possibly a cervical biopsy.
Once your cells return to normal:
we will discharge you from the Colposcopy clinic; and
your GP will perform cervical screening tests, 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, we will re-discuss your options. We will likely recommend a LLETZ treatment.
It is very important that you go to your Colposcopy clinic appointments. If you feel that you are not able to attend the Colposcopy clinic every 6 months then conservative management is not an appropriate treatment for you. 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. After 2 years we will offer a LLETZ.
1 in 2 cases of CIN2 will go back to normal without treatment.
Your Colposcopy team will talk through all options for managing cell changes with you, including monitoring or treating. They will also explain the risks and benefits of the different options.
The benefits of conservative management (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 conservative management (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. You can contact the Colposcopy clinic if you are feeling worried or concerned about your treatment.
It is important to understand the benefits and risks of any options for managing cell changes. You must 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 the Colposcopy Administration team.
Colposcopy Administration team
Telephone: 01233 616700 (for all hospital sites)
Further information
[Web sites last accessed 31 August 2026]
We have used the term ‘women’ throughout this leaflet. When we use this term we also mean people with female reproductive organs who do not identify as a woman. East Kent Hospitals is committed to supporting people of all gender identities. Please tell your midwife or doctor how you would like them to address you, so we can be sure to get this right.
References
Lellé, R.J., Küppers, V., (2023) Colposcopy: Comprehensive Textbook and Atlas
[Web sites last accessed 31 August 2026]
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