Gynecology
Here you will find analyses of geographical variation in the use of healthcare services within gynecology in Norway. The analyses include updates of selected chapters from the Gynecology Healthcare Atlas.
Here you will find analyses of geographical variation in the use of healthcare services within gynecology in Norway. The analyses include updates of selected chapters from the Gynecology Healthcare Atlas.
Number of women who receive embryo transfers per 1,000 women, 18–46 years
In vitro fertilization (IVF) is the most common form of assisted reproduction, where the woman's egg is fertilized outside the body and returned when cell division has started. In Norway, around 4,000 women receive this treatment each year, which corresponds to more than 4 per 1,000 women aged 18-46 years. These numbers only include women who have received transfer of an embryo to the uterus, and are therefore somewhat lower than the actual number of women in IVF treatment.
There was a clear decline in IVF treatments in the corona year 2020, and the rate has since partially recovered to what it was before corona. The catchment areas with the highest rates were the ones with the greatest decline in 2020, something that has contributed to reducing the geographical variation.
There is geographical variation in the proportion of patients who are 39 years or older. In 2024, 4.1% of women in the Fonna catchment area who received IVF treatment were 39 years or older; in Lovisenberg and Diakonhjemmet, this proportion was 29%. These variables are age-adjusted, so the variation is not due to demographic differences between the catchment areas.
This analysis complements the statistics on assisted fertilization on the pages of the Directorate of Health.
The analysis is based on activity data from the Norsk pasientregister (NPR) for somatic specialist health services. This analysis includes only data from public hospitals.
The sample consists of women aged 18-46 years with contacts coded with procedure code LCA30, LCW30K or LCW31K (transfer of egg or embryo to the uterus).
Where the patient is treated is divided into two categories:
In order to compare the catchment areas and between years, the rates have been adjusted for gender and age. The adjustment was done using the direct method with the countrys population in 2023 as the reference population.
SKDE is solely responsible for the interpretation and presentation of the data provided by NPR. FHI/NPR is not responsible for analyses or interpretations based on the data.
Number of cervical biopsies per 1,000 women, 18 years and older
The number of biopsies has increased by 23% over the period, from 18,300 in 2017 to 22,400 in 2023. There is significant geographical variation in biopsy rates, with the areas with the highest rates performing about three times as many biopsies per 1,000 women compared to the areas with the lowest rates. This variation is therefore classified as unjustified. The areas for Førde, Finnmark, UNN, and Helgeland HF consistently have high biopsy rates, while the areas for Akershus, Møre og Romsdal, and Sørlandet HF consistently have low rates.
Almost half of the biopsies are performed by private practitioners for the country as a whole, but there are significant differences between the areas.
The proportion of those who received conization fell from 29% in 2017 to 22% in 2023. There are significant geographical differences in the proportion of conizations within 6 months after a biopsy. In the area for Førde HF, 17% were conized in 2023, while 32% were conized in the area for Sørlandet HF. The area for Førde HF had the highest biopsy rate in 2023, while the area for Sørlandet HF had the fifth lowest biopsy rate. Correlation analysis shows that there is a negative relationship between biopsy rate and the proportion of conizations in the areas.
The analysis is based on data from the Norwegian Patient Registry (NPR) for specialist healthcare services. The data includes activity in public hospitals, publicly funded private hospitals, and specialists in private practice under public funding contacts.
The sample consists of procedures with the procedure code for cervical biopsy: LDA10, LDA20, or LDA96 at hospitals or with tariff code 212a at private specialists.
Conization is defined as a procedure within 6 months after a biopsy, and conization is defined by the procedure codes LDC00 or LDC03 at hospitals or tariff code 210 at specialists.
The place of treatment is divided into three categories:
In order to compare the catchment areas and between years, the rates have been adjusted for gender and age. The adjustment was done using the direct method with the population in 2023 as the reference population.
SKDE is solely responsible for the interpretation and presentation of the data provided by NPR. FHI/NPR is not responsible for analyses or interpretations based on the data.
Number of procedures per 1,000 women, 16 years and older
During the period 2015 - 2019, the number of procedures remained stable at just over 4 000 per year. In 2020, the number of procedures decreased by approximately 20% compared to the period 2015 - 2019. After the pandemic, the number of procedures increased slightly each year. From 2023 to 2024, there was a larger increase, and in 2024, a total of 4171 procedures were performed. The median age of those undergoing surgery has remained stable at 63 years throughout the period from 2015 to 2024.
The geographical variation has been significant throughout the period from 2015 to 2024. From 2023 to 2024, the rate for residents in the Finnmark catchment area decreased from 4.4 to 3.0 procedures per 1 000 inhabitants. This resulted in less geographical variation in 2024 compared to 2023. The catchment areas of OUS, Diakonhjemmet, Lovisenberg, Akershus, and Vestfold have had low rates throughout the period from 2015 to 2024. The catchment areas of Finnmark, Helgeland, and Fonna have had high rates throughout the period 2015 - 2024.
The extent of treatment in private facilities is very limited.
Nationally, the proportion of procedures performed as day surgery increased from 40.5% in 2023 to 45.6% in 2024. In the catchment areas of Finnmark, Sørlandet, Telemark, OUS, and Diakonhjemmet, less than 10% of operations were performed as day surgery in 2024, while in the catchment areas of St. Olav and Nordland, the corresponding proportion was over 80%. The largest increase was in the Helgeland catchment area, where the proportion increased from 10% in 2023 to 41% in 2024.
The analysis is based on activity data from the Norwegian Patient Register (NPR) for somatic specialist health services. The data includes activity in public hospitals and private hospitals that provide publicly funded services. Data from specialists under public funding contracts are not included, as this treatment is only provided in hospitals.
The sample consists of contact for women aged 16 years or older with a primary or secondary diagnosis of N81 in combination with one or more of the following procedure codes: LEF 00, LEF 03, LEF 10, LEF 13, LEF 16, LEF 20, LEF 23, LEF 34, LEF 40, LEF 41, LEF 50, LEF 51, LEF 53, LEF 96 eller LEF 97. See also Metodebok.no.
The place of treatment is divided into three categories:
In order to compare the catchment areas and between years, the rates have been adjusted for gender and age. The adjustment was done using the direct method with the countrys population in 2023 as the reference population.
SKDE is solely responsible for the interpretation and presentation of the data provided by NPR. FHI/NPR is not responsible for analyses or interpretations based on the data.
Number of procedures per 1,000 women, 16–55 years
The number of operations for endometriosis increased from 1,272 to 2,431 in the period from 2015 to 2024. This represents an increase of 91 per cent. The median age of those operated on, aged 16 to 55, was 42 years in 2024.
There is considerable geographical variation in surgeries for endometriosis. In 2024, the area with the highest rate had four times as many surgeries as the area with the lowest rate. The catchment area for Vestfold Hospital Trust consistently had a high rate throughout the period, and the highest rate from 2019 onwards. The catchment areas for Førde and Nord-Trøndelag Hospital Trusts consistently had low rates during the same period.
The proportion of surgeries involving hysterectomy remained at around 40% from 2019 to 2024. In 2024, hysterectomy was performed in more than half of the surgeries for endometriosis in the catchment areas for Vestfold (61%), Telemark (56%), Nord-Trøndelag (56%), UNN (54%), and St. Olav (54%). In contrast, the proportion of hysterectomies was significantly lower in the catchment areas for Førde (17%), Lovisenberg (21%), OUS (21%), and Diakonhjemmet (23%).
The number of surgeries performed at private hospitals has been low, ranging from none in the first three years from 2015, to an average of 11 per year over the past four years.
The analysis is based on activity data from the Norwegian Patient Register (NPR) for somatic specialist health services. The data includes activity in public hospitals and private hospitals that provide publicly funded services. Data from specialists under public funding contracts are not included, as this treatment is only provided in hospitals.
The sample consists of women aged 16-55 years registered with a primary or secondary diagnosis of N80, N941, N944, N945 or N946 in combination with one or more of the following procedure codes: LCD00, LCD30, LCD96, LCD10, LCD40, LCD01, LCD04, LCD11, LCD31, LCD97, LCC10, LCC11, LCC20, JAL21, JAL24, JAP00, JAP01, JAL20, JAL21, JAA10, JAA11, LAC00, LAC01, LAC10, LAC11, LAC20, LAC21, LCF00, LCF01, LAD00, LAD01, LAE10, LAE11, LAE20, LAE21, LAF00, LAF01, LAF10, LAF11, LAF20, LAF30, LBD00, LBD01, LBE00, LBE01, LCC00, LCC01, LCC05, LCC96, LCC97, LCF97 or LCF96.
Hysterectomy is defined by one or more of the following procedure codes: LCD00, LCD30, LCD96, LCD10, LCD40, LCD01, LCD04, LCD11, LCD31, LCD97, LCC10, LCC11, or LCC20, and the remaining procedure codes are defined as other interventions.
The place of treatment is divided into three categories:
In order to compare the catchment areas and between years, the rates have been adjusted for gender and age. The adjustment was done using the direct method with the population in 2023 as the reference population.
SKDE is solely responsible for the interpretation and presentation of the data provided by NPR. FHI/NPR is not responsible for analyses or interpretations based on the data.