Pseudocyesis also called false pregnancy is a form of somatic body disorder, where a non-psychotic and non-pregnant woman feels and belief she is pregnant even after pregnancy has been ruled out. It is a rare condition common in society where fertility and child birth is essential for a stable relationship. False pregnancy is common among women of reproductive age and can also be seen in women who are already in menopause.
PSEUDOCYESIS OR FALSE PREGNANCY; MY ENCOUNTER
As a junior resident at the antenatal booking clinic, I met an elderly woman who should be in menopause by her age. She came to book her pregnancy with a positive pregnancy test result. This pregnancy test was done at a private laboratory. I asked when her last menstrual period was and she said 5years ago. I concluded the conception was via assisted reproductive technology so, I asked for the embryo transfer date. She said the pregnancy was conceived naturally. She went ahead to explain when she saw the surprise look on my face. That it was after a session of prayer and fasting, the man of God asked her to go for a pregnancy test at a specified laboratory. There she had a positive result and was also told the pregnancy was 3months old.
Furthermore, I asked for the usual pregnancy symptoms, she had non except for abdominal distension. I told her it is not feasible to know how old a pregnancy is from a pregnancy test strip. She was examined, there was no physical signs of pregnancy noted. A request for another pregnancy test in our facility came out negative. An obstetrics scan was done with no confirmation of pregnancy instead, features seen were in keeping with menopause. She was referred to the mental health physician after counselling on the findings.
CAUSES OF PSEUDOCYESIS
The cause of false pregnancy is not known but has been associated with some psychological and social pressure to give birth to a child. This can alter the brain chemistry and result in symptoms and signs of pregnancy. Psychotropic medication may contribute to the occurrence or perpetuation of pseudocyesis by causing side effects that mimic pregnancy symptoms. These include nausea, weight gain, constipation, the breast producing milk, and loss of menses. Couvade syndrome mostly affect males whose wives are pregnant. They present with some symptoms and signs of pregnancy. Some women that stay with pregnant women can also develop this condition.
Also, medical condition such as gestational trophoblastic disease present with signs and symptoms of pregnancy. Pituitary tumours can cause loss of menses and milk discharge from the breast. Pelvic tumours, Cushing’s syndrome, liver disease, bowel obstruction, constipation, excess swallowed gas, fluid in the abdomen, enlarged abdominal organ can cause abdominal enlargement. Stress, weight loss, polycystic ovary syndrome may lead to missed menstrual periods and mistaken as a sign of pregnancy.
SYMPTOMS AND SIGNS OF PSEUDOCYESIS
These might last for a short time or even years and these symptoms and signs include;
- Nausea and vomiting
- Loss of menses
- Abdominal distension; which may be due to excess fat, gas or even fluid
- Feeling of movement of the baby; movement of the intestine is often confused for this
- Breast changes such as tenderness, enlargement and even milk discharge
- Abdominal pain
- Urinary frequency
MAKING THE DIAGNOSIS OF PSEUDOCYESIS
The diagnosis is made when a non-psychotic woman with symptoms and signs of pregnancy, negative pregnancy test and scan results still belief she is pregnant.
TREATMENT OF PSEUDOCYESIS
The first step to helping women with false pregnancy is to break the news to them in an empathetic manner that they are not pregnant. This will help avoid agitation, depression and ‘doctor shopping’. The condition might be a coping mechanism to these women and so, should be carefully handled. The mental health physician should be consulted for psychotherapy. Where possible, the stressor should be identified.
Therapy can include important friends and family members where a modifiable stressor for the condition has been established in the patient. For patient with pseudocyesis co-existing with depression or psychosis; antidepressant, mood stabilizers or antipsychotic can be prescribe. Medical conditions that cause symptoms and signs suggestive of pregnancy should be treated. After or during psychotherapy, hormonal medications can be prescribed to trigger withdrawal bleeding. All these can help the patient develop insight and resolution of symptoms.
COMPLICATIONS OF FALSE PREGNANCY
Women with pseudocyesis are at risk of developing other psychiatric disorders such as;