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 procedures per 1 000 women, 16-55 years
The number of surgeries for endometriosis increased from 1,272 in 2015 to 2,154 in 2023. There is significant geographical variation in surgeries for endometriosis, with the area with the highest rate having more than three times as many surgeries as the area with the lowest rate. The catchment area for Vestfold HF consistently had a high rate during the period and the highest rate from 2019 onwards. The catchment areas for Førde and Nord-Trøndelag HF consistently had low rates during the period. The proportion of surgeries involving hysterectomy increased from 34 % in 2015 to over 42 % in 2023. In 2023, hysterectomy was performed in more than half of the surgeries for endometriosis in the catchment areas for Helgeland (69 %), Telemark (58 %), Østfold (57 %), Vestfold (53 %), Møre og Romsdal (52 %), and UNN HF (51 %). In the catchment areas for Lovisenberg (19 %), Diakonhjemmet (23 %), and OUS HF (23 %), the proportion of hysterectomies was significantly lower in 2023. The proportion of patients treated within their own health trust has remained stable at around 60% for the country as a whole during the period. The average age of women undergoing surgery for endometriosis has decreased from just over 37 years to just under 36 years from 2015 to 2023, and the average age of those undergoing hysterectomy has decreased from almost 43 years to 41.5 years during the period.
Number of women who receive embryo transfers per 1,000 women, 18 to 46 years old
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, just under 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 2023, 8.7% of women in the Fonna catchment area who received IVF treatment were 39 years or older; in Lovisenberg, this proportion was 34%. 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.
Number of procedures per 1 000 women
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 annual number of procedures has increased each year, and in 2023, around 3,700 procedures were performed. The median age was 64 years in 2023 and 63 years for the perioden 2015-2022.
The geographical variation has been significant throughout the period from 2015 to 2023. The variation has been somewhat greater in the period after the pandemic (2021-2023) than in the period before the pandemic (2015-2019). The catchment areas of OUS, Diakonhjemmet, Lovisenberg, Akershus, and Vestfold have had low rates throughout the period from 2015 to 2023. The catchment area of Finnmark has had the highest rate throughout the period 2015-2023, except for the pandemic year 2020. Helgeland, Fonna, and Nord-Trøndelag have also had high rates throughout the period 2015-2023.
The extent of treatment in private facilities is very limited.
Nationally, the proportion of procedures performed as day surgery increased from 24% in 2015 to 40.5% in 2023. There is significant variation between the catchment areas. In the catchment areas of Finnmark, OUS, Sørlandet, and Lovisenberg, less than 10% of operations were performed as day surgery in 2023, while in the catchment area of St. Olav, the corresponding proportion was 84%.
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.
