False (Phantom) Pregnancy: Causes, Symptoms, and Treatments
The term “false” or “phantom” pregnancy refers to a condition where a woman conceives after she has been pregnant for one month but does not give birth. A true pregnancy would usually last from nine months to three years. However, there are cases when it takes longer than that.
Some women have had their pregnancies terminated because they were unable to carry them through to delivery. Other times, these women have given birth prematurely.
Some doctors believe that some women are born without a uterus and ovaries. They say that they do not produce hormones which cause a woman to conceive. But others claim that the problem lies elsewhere and that hormones play a role in conception too.
There is no conclusive proof either way, so the term “false” or “phantom” pregnancy is used to refer to any case where a woman conceives while still pregnant.
What causes false (phantom) pregnancy?
There are many theories about what might cause false (phantom) pregnancy. One theory suggests that the reason why some women do not become pregnant is because they lack certain types of cells called follicles in their fallopian tubes. Normally, these cells help to transport the ovum from the ovary to the uterus. They also support the growth of an embryo after conception. A woman without these cells is probably never going to get pregnant even if she has regular sexual activity with a male partner.
However, in other cases, it is hormones that are at fault for causing false pregnancies. One chemical called hCG (human chorionic gonadotropin) is found in pregnant women. It helps to sustain the pregnancy.
Some women have too much of this hormone and it prevents them from getting pregnant. Others have too little of it and also never become pregnant even after prolonged sexual activity with a male partner.
In some cases, women have irregular periods, sometimes very light ones or sometimes none at all. These women produce hormones that prevent them from getting pregnant. When they do become pregnant, however, the hormones change and this is when they get their periods back.
If they happen to conceive during one of their non-period cycles, then they will think that they have conceived since they are getting their periods again. This is one of the reasons why they believe that they are indeed pregnant even though they are not and why they develop a “phantom” pregnancy.
Other theories
Other factors contribute to false pregnancies too. One theory states that when a woman experiences stressful situations for an extended period of time, then she may also experience periods of false pregnancy. Some common sources of stress in many women’s lives are:
1. Poor body image
2. Family problems
3. Sexual abuse or assault
4. Eating disorders such as anorexia or bulimia
5. Substance abuse such as alcoholism, marijuana or cocaine.
Stress has a huge impact on the female body in many ways. If a woman is under a lot of stress, then her periods may become irregular or stop altogether, which is one reason why women may think that they are pregnant when they are not. Other reasons can be explained by the theories mentioned above.
Emotional factors
Sometimes when a woman experiences a stressful situation she will try to deny it and put up a front that everything is fine. This is a natural protective mechanism in people that is used to help them deal with difficult situations. Sometimes denial can go too far however and this might result in a woman developing a false pregnancy.
Let’s take an example: A woman may deny that she has an eating disorder. She knows that she is not eating properly, but she refuses to see herself as having a problem and living in a state of permanent denial about her condition. She is, however, still stressed out about her situation and this stress causes her to stop menstruating.
Her denial about her eating disorder means that she also does not seek any treatment for it and so remains in a state of false pregnancy.
A woman may also experience psychological trauma during her life. If she denies the impact of the trauma then this can also cause a false pregnancy. A woman who has been the victim of sexual abuse or assault is a good example of this.
If the woman has been abused or assaulted, then this will have obviously had a great impact on her life. If she is able to admit and accept the impact that it has had on her, then she will be able to get the treatment that she needs. If she denies the impact that it has had on her life and refuses to see it as a problem however, then this will lead to denial and a state of false pregnancy.
Menopause
In some ways, menopause is the opposite of puberty. During puberty, a woman’s body starts producing more of the hormones estrogen and progesterone. The drop in these hormones during menopause can sometimes cause the bleeding that is typical of a period.
The drop in estrogen and progesterone, as well as another hormone called chorionic gonadotrophin, causes the lining of the uterus to break down and bleed. This bleeding is what causes a woman to experience menopausal symptoms such as hot flashes and night sweats.
Some women however report experiencing bleeding even though they are well past the age of menopause. This is sometimes referred to as pseudo-menopause or medically as persistent menopausal bleeding. There are many different theories about the cause of this condition.
It is thought that both physical and emotional factors can be behind it, including stress and anxiety.
An unusual case
A report in the Nursing Times [1] describes a woman in her 50s who started having periods again even though she had undergone a full hysterectomy. This means that her uterus and both of her ovaries had been removed. This was not normal menopause, since it is unusual for women of this age to experience a cessation in their periods.
Doctors investigated and found that the woman was still producing small amounts of estrogen and progesterone. They increased her dosage of these hormones and this solved the problem.
This case suggests that a woman’s mental state can have an effect on the production of hormones in her body. It is possible for a woman to be in such a highly stressed or anxious state that she starts producing very small amounts of hormones that trigger bleeding. This is often as a result of another underlying condition such as anorexia or bulimia.
In the case above, the woman was starting to show signs of anorexia and it is thought that this triggered the bleeding that she experienced.
Psychological causes of false pregnancy
The case above suggests that a woman can experience a type of pseudo-pregnancy if she has another condition such as anorexia. It is also possible for women who are not suffering from any other conditions to experience the symptoms of pregnancy. This condition is known as pseudocyesis and its symptoms mimic those experienced during a real pregnancy.
Pseudocyesis occurs in about 0.5% of women who are not pregnant and it is commonly known as a hysterical pregnancy.
Women with this condition will typically experience the symptoms that occur during a normal pregnancy such as nausea, tenderness of the abdomen, increased size of the abdomen and even labor pains. In some instances, women have even given birth to phantom babies. These symptoms may occur with or without the belief by the woman that she is actually pregnant.
Psychologists believe that this occurs as a way for the woman’s body to invent a reason for physical changes that are occurring, such as an increase in the production of certain hormones.
A recent case has brought pseudocyesis back into the media spotlight. A 17 year old Muslim girl from India became pregnant and claimed that she did not have sexual relations with any man. This was seen as proof that she was indeed pregnant and a shrine was set up in her honor.
Over the course of 9 months she gained 35 kg (70 pounds), much of which was fluid buildup, and delivered a stillborn baby. Doctors confirmed that there was no way that she could have been pregnant and that all of her symptoms were caused by a hormonal imbalance. It is thought that the increase in her weight caused pressure on her hip that led to the release of hormones that triggered these symptoms. The teenager has not spoken since the birth and there have been concerns for her mental state.
Pregnancy-associated homicide
There are also cases on record where women have killed their children and claimed that they were pregnant, even though this was not the case. This has come to be known as a Munchausen by proxy case (named after a book written by the physician who first described the condition) and the women are typically found to be suffering from personality disorders.
One such case is that of Susan Smith. In 1995, she claimed that a black man had grabbed her child while she was waiting at a stoplight. A massive search was undertaken and widespread media coverage ensued.
After 8 days, she confessed to law enforcement that she had drowned her 3 year old son by stuffing him in a washing machine and then made the story up about the black man. She claimed that she did this because her boyfriend had broken up with her and she wanted to get back at him. She did this by setting him up as the father of the child and then having him hunted down and killed in revenge for the kidnapping. In 1997, she was given a life sentence for her crime.
The term Munchausen by proxy was coined in 1951 by the British pediatrician Kenneth Mason who described it as a form of child abuse where the mother (or mother figure) fabricates or induces illness in the child. This is done to gain (either actively or passively) the attention of medical professionals. The mother is typically a chronic liar and has no qualms about letting others, especially doctors, believe that the child is truly ill.
The illness is often either a condition that can mimic a disease or the by-product of a real disease (for example a rash on the body due to a high fever).
It is often difficult to tell the difference between Munchausen by proxy and pseudocyesis. Another condition, maternal deprivation, is also similar.
The first step is to rule out any organic condition. This is typically done via a physical examination. If this is inconclusive or if there are other concerning symptoms, it may be necessary to perform blood tests or other experiments.
The second step is to determine whether the mother truly believes that the child is pregnant or whether she has a personality disorder and is putting herself (and the child) in danger.
The third step is to determine whether the mother has any other children and whether there are signs of abuse.
As with all medical mysteries, the information available will determine which diagnostic techniques will be used to solve the case.
Sources & references used in this article:
Falsely elevated human chorionic gonadotropin leading to unnecessary therapy by TG Olsen, PR Hubert, LR Nycum – Obstetrics & Gynecology, 2001 – Elsevier
False diagnosis and needless therapy of presumed malignant disease in women with false-positive human chorionic gonadotropin concentrations by S Rotmensch, LA Cole – The Lancet, 2000 – Elsevier
Pseudopregnancy in the bitch: the current view on aetiology and treatment by WE ALLEN – Journal of Small Animal Practice, 1986 – Wiley Online Library
False-positive hCG assay results leading to unnecessary surgery and chemotherapy and needless occurrences of diabetes and coma by LA Cole, KM Rinne, S Shahabi, A Omrani – Clinical chemistry, 1999 – academic.oup.com
Phantom hCG and phantom choriocarcinoma by LA Cole – Gynecologic oncology, 1998 – Elsevier
False-positive serum human chorionic gonadotropin results: causes, characteristics, and recognition by GD Braunstein – American journal of obstetrics and gynecology, 2002 – Elsevier
Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of … by JR Lurain – American journal of obstetrics and gynecology, 2010 – Elsevier
