24 November 2020

False (Phantom) Pregnancy: Causes, Symptoms, and Treatments

phantom pregnancy
By the Editorial Comitee IVI Blog

False pregnancy, or phantom pregnancy, is a rare condition. The patient not only thinks she is pregnant, but her body displays many of the signs of pregnancy too. It is not the same as an imagined pregnancy, in which someone hopes for pregnancy with such intensity that she convinces herself that she is, in spite of the absence of physical signs. The clinical term for the condition is pseudocyesis.

Phantom pregnancy is very rare, affecting only about one in 7,000 pregnancies, but it is nothing new. The Greek ‘Father of Medicine’ Hippocrates first described it in 300 BCE. A famous historical example was Britain’s Mary Tudor in 1555. Although in the past it was often dismissed as ‘all in the mind’, medical experts now recognise that it is more than that, with physical as well as psychological causes.


What are the causes of phantom pregnancy?

It is only relatively recently that doctors have started to recognise that the causes of phantom pregnancy arise from a complex mixture of psychological and physical factors. They currently take the view that psychological causes can actually ‘trick’ the body into responding as though it is pregnant.

A strong desire for pregnancy

In a clear example of how mind and body work together, an intense desire for pregnancy can create pregnancy-like signs in the body, such as a swollen abdomen and enlarged breasts, sometimes even the sensation of foetal movement. These signs are misinterpreted by the brain as symptoms of pregnancy, triggering the production of hormones like prolactin and oestrogen which lead to actual pregnancy symptoms.

Intense fear can have similar consequences

Just as an intense desire can create signals that ‘trick’ the brain into releasing hormones as though the body really was pregnant, so an intense fear or dread of pregnancy could have the same effect on both body and brain.

Possible depressive disorders

Another theory is that certain depressive disorders can cause a hormonal imbalance which has the effect of triggering the release of pregnancy-response hormones in the brain.

Other hormone-disrupting conditions

In some cases, physical conditions unrelated to intense emotions or feelings around pregnancy can cause missed periods and abdominal enlargement as well as the changes in hormone levels that can cause the symptoms of a false pregnancy. Examples could include serious underlying conditions such as pituitary or ovarian tumours.

We can see from these examples that cases of phantom pregnancy involve actual changes in the body’s production of hormones. Sometimes to the extent that even doctors, if it were not for diagnostic tools such as ultrasound scans, would not be able to tell the difference. As such, it is not a condition that is in any way the fault of the patient, and it is always to be clearly distinguished from an imaginary pregnancy or a deliberate pretence of pregnancy.


The symptoms of phantom pregnancy

The symptoms of a false pregnancy, while of course being very similar to the symptoms of a real pregnancy, vary from one patient to another, just as they do in reality. These are likely to start off with the signs of early pregnancy such as a missed period and develop over time into the symptoms of a more advanced pregnancy. Symptoms can include:

  • Cessation of the normal menstrual periods;
  • Nausea and even vomiting associated with the classic ‘morning sickness’;
  • A swollen belly, increasing in size as the months go by;
  • Breasts which become enlarged and tender, with characteristic changes to the colour of the nipples, even sometimes the production of breast milk;
  • A sensation of foetal movements;
  • Increased appetite and weight gain;
  • Enlargement of the uterus, along with associated softening of the cervix.

The various symptoms can last for a matter of a few weeks or even for nine months. It depends on whether appropriate treatment is available and whether the patient can be helped to understand the situation.


Phantom pregnancy treatment

The first step towards treatment is for the doctor to conduct tests to establish the true situation. It is interesting that the incidence of the condition has dropped quite dramatically since the availability of over-the-counter pregnancy tests. In the 1940s, one in around 250 pregnancies was in fact a case of pseudocyesis. Now that self-diagnosis is much more readily available, that number has dropped to around one in 7,000 pregnancies.

Diagnostic testing

A doctor will normally carry out the same tests as for a normal pregnancy. That is an evaluation of the symptoms, a pelvic examination and an ultrasound scan. In the case of a phantom pregnancy, there will be no heartbeat and no foetus visible on the ultrasound. Occasionally however, the examination will discover some of the symptoms associated with pregnancy, such as an enlarged uterus and softened cervix.

Psychological support

The most important aspect of treatment for a false pregnancy is not merely to ‘prove’ to the patient that she is not in fact pregnant, although this is the essential first step. When a woman has believed she is pregnant, sometimes for several months, learning the truth can be devastating. It causes real grief and a sense of bereavement. Psychological support is absolutely essential, from the doctor conducting the tests being very gentle in breaking the news, to arranging for further professional counselling.


Getting in touch with IVI

Thankfully, very few of our patients will ever experience the distress caused by a phantom pregnancy. But many know all too well the stress and disappointment that can come when a longed-for pregnancy fails to take place. Unlike a false pregnancy, fertility problems are not rare at all, affecting around one in six couples of reproductive age. Happily however most cases are treatable with well-established assisted reproduction techniques.

If you have any concerns about your fertility at all, do talk to us. We can conduct a full evaluation and investigate the causes of any problems. Whether you just need a little help with a simple technique such as intrauterine insemination or more complex treatment such as the well-known in vitro fertilisation, we hope to help you on your way to your very own happy ending.

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