Significant geographical differences within gynaecology
On Wednesday 9th January, the eighth national health atlas will be published on the website helseatlas.no. The new atlas focuses on gynaecology.
Published 2/27/2026
Photo: Colourbox
The Health Atlas for Gynaecology is primarily based on data from the Norwegian Patient Register and describes a selection of specialist healthcare services in gynaecology provided to women over 16 years old in Norway during the period 2015–2017. There was significant or very significant geographical variation in the use of most services examined in the Health Atlas for Gynaecology.
The Health Atlas for Gynaecology is the eighth health atlas published on www.helseatlas.no, and was created by the Centre for Clinical Documentation and Evaluation (SKDE) in Health North in collaboration with a broadly composed reference group.
Many are operated on for urinary incontinence in Finnmark – few in Oslo
Norwegian figures show that approximately 8% of the female population over 20 years old suffers significantly from urinary incontinence. Urinary incontinence can be treated conservatively through various forms of training or medication, or surgically.
The Health Atlas for Gynaecology shows large differences in the use of surgical interventions for urinary incontinence. In Finnmark, 8 times more women are operated on than in the area with the fewest operations. These differences are too great to be attributed to patients' own preferences regarding conservative or surgical treatment.
Both Finnmark and Nord-Trøndelag are well above the national average, while the areas in Oslo and central parts of Eastern Norway perform far fewer operations than the national average.
The areas in Oslo also have low figures for surgical treatment of bleeding disorders, vaginal and uterine prolapse, as well as for hysterectomy and sterilisation. The areas of Nord-Trøndelag and Finnmark generally have high figures for the same procedures.
Many are still operated on with open surgery
Surgical removal of the uterus (hysterectomy) is a procedure performed for various reasons. There is significant geographical variation in the use of hysterectomy. In Helgeland and Nord-Trøndelag, approximately 2.4 times as many hysterectomies were performed as in the Oslo area.
Nationally, the proportion of hysterectomies performed as open surgery has decreased in recent years, from about 40% in 2013 to around 20% in 2017, while the proportion of procedures with laparoscopic and vaginal access has increased. However, there are still significant geographical disparities in the use of open procedures in gynaecological surgery. In the areas of Vestfold and Bergen, only 14% of women who had their uterus removed were operated on with open surgery, while in the areas of Førde and UNN, open surgery was used in 40% of cases.
The decline in the use of open surgery nationwide indicates that the trend is moving towards an increasing replacement of open surgery with laparoscopic and vaginal procedures. Given the large differences, it can be said that several areas are lagging behind in this development.
Different practices regarding self-determined abortion
Each year, approximately 12,000 Norwegian women choose to terminate their pregnancy before the twelfth week. Medical treatment, where the abortion can be carried out at home, is the most common and medically preferred method. Surgical abortion is performed if medical treatment is ineffective, or if the woman herself requests it.
The Health Atlas for Gynaecology shows that nationally, about 13% of abortions were performed using surgical interventions, but the geographical differences are significant. Over 30% of women in the Østfold area who chose to terminate a pregnancy had this performed as a surgical procedure, while only 1.9% of women residing in the Stavanger area underwent surgical abortion.
The figures indicate that the proportion of surgical abortions is generally high in Oslo and central parts of Eastern Norway.
Unnecessary sampling during gynaecological examinations in the north?
Women aged between 25 and 69 are recommended to have routine cervical screenings every three years to check for cellular changes. If there is suspicion of cancer based on the results of a cell sample or HPV test, a tissue sample (biopsy) is often taken from the cervix. At the same time, the cervix is examined with a so-called colposcope, which is a type of microscope.
The Health Atlas for Gynaecology shows that there are very large geographical differences in the use of colposcopy and tissue sampling during gynaecological examinations. In Nordland and Vestfold, ten times as many colposcopies and tissue samples were performed compared to the areas with the lowest figures.
Northern Norway, in general, stands out with high figures for tissue sampling from the cervix. Seven times more tissue samples were taken from women residing in Nordland than from those living in Møre and Romsdal, which has the lowest figures.
The results suggest an overuse of colposcopy during gynaecological examinations, primarily related to consultations with private specialists.