Pseudocyesis, also known as false pregnancy, is a condition in which a non-pregnant woman exhibits signs and symptoms of pregnancy. This condition was first described by Hippocrates around 300 BC and was originally referred to as “false conception” or “wind pregnancy”. Pseudocyesis can mimic all the signs and symptoms of true pregnancy, including cessation of menstruation, breast engorgement and tenderness, abdominal distention, labor pains, and vomiting. However, there is no fetus present. This article will explore the proposed causes and mechanisms behind pseudocyesis.
What is pseudocyesis?
Pseudocyesis is the mistaken belief that one is pregnant when one is not. The most common hallmarks of pseudocyesis are:
- Amenorrhea – the absence of a menstrual period
- Lactation – breast secretions
- Distention of the abdomen
- Sensation of fetal movement
- Nausea and vomiting similar to morning sickness
- Presence of a uterus larger than normal
These symptoms strongly mimic those typical of pregnancy. However, when examined through ultrasound or other tests, no fetus or placenta is detected. Pseudocyesis is estimated to impact between 1 and 6 out of every 22,000 births. It has been documented in many mammals but is most common in humans and other primates.
What causes pseudocyesis?
The exact mechanisms leading to pseudocyesis are not fully understood. However, several factors are believed to play a role:
Hormonal Changes
Pseudocyesis often begins with hormonal disruptions that mimic the physiology of early pregnancy:
- Increased estrogen production from the ovaries
- Increased prolactin release from the pituitary gland
- Decreased gonadotropin secretion
These changes appear to arise from psychological influences rather than physical causes. Elevated prolactin levels are thought to lead to breast enlargement and milk production.
Uterine Changes
The uterus may become enlarged, soft, and distended as it does in true pregnancy. This is likely due to increased blood flow and fluid accumulation. Contractions and labor pains can also occur, triggered by prostaglandins released by the uterus.
Weight Gain
Appetite often increases during pseudocyesis, leading to weight gain concentrated around the abdomen and buttocks. This contributes to the appearance of an expanding pregnant belly.
Stress and Psychological Factors
Stress and emotional disturbances are strongly associated with the onset of pseudocyesis. Contributing psychological factors may include:
- An intense desire to become pregnant
- Infertility
- Miscarriage or loss of a pregnancy
- Family or social pressures to conceive
- Relationship problems and instability
- Sexual dysfunction or abuse
- Mental health disorders such as depression or schizophrenia
These influences are thought to promote hormonal and physical changes through neural pathways linking the brain to the reproductive system.
Physical Stimuli
Physical sensations from sources other than a fetus can mimic the movements and growth experienced in pregnancy:
- Intestinal gas and muscular spasms may feel like fetal kicking
- A distended bladder can enlarge the abdomen
- Accumulated abdominal fat and constipation can mimic an expanding uterus
Misinterpretation of these stimuli as signs of pregnancy may trigger or exacerbate the psychological and hormonal changes underlying pseudocyesis.
Risk Factors
Certain factors appear to increase a woman’s risk of developing pseudocyesis:
- Being of reproductive age – Cases most commonly occur between the ages of 20 and 44.
- Irregular menstrual cycles – Makes it easier to mistake amenorrhea for early pregnancy.
- Obesity – Excess fat accumulation can distend the abdomen.
- Infertility – Accounts for around 1/3 of cases.
- History of miscarriage – Can fuel a strong wish for pregnancy.
- Emotional or mental health disorders – Particularly depression and anxiety.
- Naivety about reproduction and pregnancy – More common in adolescents.
- Sudden cessation of contraceptives – May disrupt menstruation.
Pseudocyesis appears to be more prevalent in rural settings and developing countries. Rates also seem higher in societies with strong cultural emphasis on fertility and motherhood.
Mechanisms
The development of pseudocyesis stems from a complex interplay between psychological factors and hormonal dysregulation:
1. Wish for pregnancy initiates changes
A strong desire to become pregnant, conscious or unconscious, is believed to spark the process. This wish may stem from personal hopes or external pressures around fertility and motherhood.
2. Hormones disrupted
Through neural signals, this wish for pregnancy leads to altered hormonal signaling involving estrogen, prolactin, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). The hormonal profile starts to mirror early pregnancy.
3. Physical changes occur
In response to the hormonal alterations, physical changes emerge. These include menstrual cessation, breast enlargement, abdominal distension, uterine contractions, and possible weight gain.
4. Pregnancy signs reinforced
The physical changes are interpreted as confirming signs of pregnancy, fuelling the conviction of conception. This sets up a positive feedback cycle further promoting hormonal and physical changes.
5. Stimuli misattributed as fetal movement
Sensations from intestinal activity, bladder distension, fat accumulation, and muscle spasms may feel like fetal movement. These perceptions strengthen belief in the pregnancy.
6. Pseudocyesis self-propagates
Through this cycle, the manifestations of pseudocyesis become increasingly pronounced until reaching full false pregnancy. Without interruption, symptoms can be maintained for 9 months or more.
Diagnosis
Pseudocyesis produces symptoms so similar to true pregnancy that diagnosis can be challenging. However, there are several definitive ways to confirm or rule it out:
- Pelvic exam – Lack of changes to the cervix and uterus can indicate absence of pregnancy.
- Blood and urine tests – Will show none of the hormone markers of pregnancy.
- Ultrasound – No fetus will be detected via abdominal or transvaginal ultrasound.
- MRI – Scans will not reveal an embryo or placenta.
These tests can clearly differentiate between pseudocyesis and real pregnancy. However, it is important to deliver results sensitively due to the likelihood of strong emotions and disappointment.
Treatment
Pseudocyesis will usually resolve spontaneously over time, typically within several weeks or months after the expected delivery date. However, treatment can help address contributing factors and minimize symptoms:
Address underlying causes
Counseling and psychotherapy are recommended to identify and resolve any contributing emotional or psychological issues. Medications may be prescribed for mental health disorders. Relationship counseling may help address family pressures or infertility-related stress.
Hormonal regulation
Hormonal imbalances are addressed through medications such as oral contraceptives, gonadotropin-releasing hormone analogs, and bromocriptine. These help restore normal menstrual cycles and hormone levels.
Provide education
Explaining the anatomy and physiology underlying reproduction and pregnancy can help overcome misconceptions. This knowledge can prevent reoccurrence of pseudocyesis.
Treat physical symptoms
Distention and pain may be relieved through warm packs, mild pain relievers, and wearing loose clothing. Laxatives and dietary changes can relieve constipation contributing to abdominal enlargement. Weight management may also help.
Complications
Pseudocyesis itself does not cause long term medical complications. However, there are some associated risks:
- Misdiagnosis – Pseudocyesis mistaken for true pregnancy can lead to inappropriate medical care.
- High recurrence – Around 33% of women experience repeat episodes if underlying factors are unresolved.
- Depression – Disappointment following disproven pregnancy may trigger depressive disorders.
- Relationship conflict – Strain with the supposed father can occur.
- Social difficulties – Challenges may emerge due to reactions from family, friends, and coworkers.
Seeking prompt diagnosis and psychological treatment helps minimize these potential complications.
Prevalence
The reported rates of pseudocyesis vary widely, likely due to differences in diagnostic criteria and social factors between populations:
| Country or Region | Estimated Prevalence |
|---|---|
| United States | 1 to 6 per 22,000 births |
| United Kingdom | 1 in 250 pregnancies |
| France | 1 in 160 pregnancies |
| India | 1 in 160 to 1 in 285 pregnancies |
| Africa | 1.2% to 6.8% of infertile women |
Studies also report higher rates among rural populations compared to urban settings. The prevalence in developed nations has decreased over past decades.
History
False pregnancy has been observed since ancient times. Some key points in its recorded history include:
– First described by Hippocrates around 300 BC – Termed “pseudocyesis” in 1557
– Linked to emotional factors as early as 1603 – French physician reported case triggered by intense wish to bear heir
– Reported in medical journals as “spurious pregnancy” in 17th-18th centuries
– John Mason Good coined term “pseudocyesis” in 1823
– First statistical analysis published in 1948 – Found 1 case per 250 pregnancies
– Research on hormonal causes emerged in 1950s-60s – Implicated prolactin and pituitary tumors
– MRI and ultrasound in 1970s-80s improved diagnosis and confirmed lack of fetus
– Psychological factors gained prominence again in 1970s – Case reports linked to depression and stress
– Rate of reported cases decreased through the 20th century – Likely due to improved diagnosis and changing societal norms
While less prevalent today, pseudocyesis continues to be reported and studied worldwide. Scientific understanding has progressed but much remains unknown about its exact mechanisms.
Notable Cases
Some well-known instances of pseudocyesis include:
- Mary Tudor – The Queen of England in 1554 believed she was pregnant but no child was delivered. Political pressures to produce an heir may have contributed.
- Queen Marie of Romania – In the 1920s she claimed to be 7 months pregnant but no baby materialized. She had previously endured several miscarriages.
- Joanna of Castile – The Spanish Queen reputedly suffered from pseudocyesis repeatedly between 1509-1518 amid intense pressure to conceive.
- “The Miller’s Tale” – This Chaucer story from 1387 contains one of the first literary depictions of false pregnancy.
- Medical case files – Early publications documented cases attributed to virgins, nuns, and menopausal women.
These cases demonstrate pseudocyesis occurring across class and eras, often linked to intense social expectations around reproduction.
In Other Mammals
Pseudopregnancy has been observed in many mammals including rats, mice, rabbits, dogs, cats, marsupials, horses, cows, and non-human primates. It appears fairly common in certain captive species. Examples include:
- Dogs – Up to 50-75% of intact bitches may exhibit pseudopregnancy after estrus.
- Rabbits – Can manifest prolonged nesting behaviors and mammary changes.
- Mice – Hormonal signaling similar to humans elicits pseudo-gestation.
- Horses – Rare cases with abdominal enlargement and lactation reported.
- Bonnet macaques – Social stress linked to high rates around 12-14%.
As in women, psychological influences interacting with reproductive hormones are implicated in non-human mammals. However, manifestation details vary between species.
Conclusion
Pseudocyesis is a complex condition arising from psychological disturbances intersecting with hormonal and physiological processes. While its manifestations closely mimic pregnancy, medical testing can readily confirm its absence. Treating any contributing emotional or mental health factors is key to resolution and preventing recurrence. Understanding both its psychological underpinnings and reproductive endocrinology remains important to elucidating pseudocyesis origins and mechanisms. With sensitive management, false pregnancy can be overcome allowing individuals to attain genuine conception goals or pursue alternate life paths.