Purpose: The primary objective of this study was to determine the prevalence of abnormal cervical lesions and associated factors and the secondary objective was to assess adherence to post-cryotherapy treatment recommendations, among women in Harari region, eastern Ethiopia. Materials and Methods: This study was conducted in two public hospitals in Harar city from January 1 to May 30, 2019. A facility-based descriptive cross-sectional study was conducted and a total of 1181 women were included in the study. Structured face-to-face interviews with women aged 25-49 years were used to collect information on precancerous cervical lesion screening and adherence to post-cryotherapy treatment. Visual inspection with acetic acid (VIA) method was used to screen women for precancerous cervical lesions. The collected data were entered into Epi Info software and then exported to SPSS software for analysis. Logistic regression analysis was used to check the association between independent variables and abnormal cervical lesions. Results: The prevalence of abnormal cervical lesions among the participants screened was 24.5% (95% CI = 20.8-27.9%). Having no formal education (AOR = 2.68, 95% CI = 1.32-5.46), lack of awareness of cervical cancer, (AOR = 2.65, 95% CI = 1.68-4.23) and having a husband with history of multiple sexual partners (AOR = 1.75, 95% CI = 1.13-2.7) were independently associated with abnormal cervical lesions. From the respondents who received cryotherapy treatment prior to the study, the majority, 92.9% (95% CI = 76.5-99.1), adhered to the post-cryotherapy treatment recommendations. Conclusion: We found that the prevalence of abnormal cervical lesions in this area was high. Having no formal education, lack of awareness of cervical cancer and having a husband with history of multiple sexual partners were independently associated with having abnormal cervical lesions. The federal ministry of health and other stakeholders should focus on the primary prevention method (HPV vaccination) at an earlier stage to reduce the prevalence of abnormal cervical lesions in the study area. Harari regional health bureau should provide awareness creation activities and special attention should be given to uneducated women.