phantom pregnancy (Pseudocyesis & Couvade Syndrome)

Ever since the marriage Lisa always wanted to have kids. But it always seemed a distant dream because of the couple’s infertility. After a few months, she noticed an interruption of the menstrual cycle. Her belly gradually enlarged and she even started to feel fetal movements. She was fully convinced that her dream of having children is finally going to be a reality. Everything was going well until the ultrasound scan at the doctor's office revealed that there was no fetus. This is the rare psychiatric disorder pseudocyesis, in which the patient firmly believes she is pregnant and even develops symptoms of pregnancy.

Symptoms of this condition include,
- A swollen belly
- Breast engorgement and milk production
- Amenorrhea or interruption of the menstrual cycle
- the feeling of fetal movements
- nausea and vomiting
These symptoms usually last for a few weeks, until they visit a doctor to confirm the pregnancy. If the woman doesn't see a doctor, the symptoms can last for nine months or even for years. Though this is common with females, there are case reports of men with pseudocyesis. There’s a related disorder in men called couvade syndrome. In this condition, the husband experiences similar symptoms as the pregnant wife, like morning nausea and backaches. But unlike in Pseudocyesis, these patients don’t believe they are pregnant.
So, what causes pseudocyesis?
• The exact cause remains a mystery. But the medical experts think that the mind tricks the body to develop pregnancy symptoms. Let me explain.
• Many of the women with pseudocyesis have had an intense desire to get pregnant or an intense fear of getting pregnant. The desire for pregnancy could be due to a history of infertility, miscarriages, or a lost child.
• And most of these women suffer from mild to severe depression.
• These psychological conditions can cause a deficit in hormones, dopamine, and norepinephrine in the brain, and increased activity of the sympathetic nervous system.
• When the dopamine and Norepinephrine levels are low, pituitary hormones like GnRH, LH, FSH, and Prolactin are increased due to lack of inhibition.
• LH and FSH hormones stimulate the ovaries in females. These hormone changes ultimately lead to amenorrhea or pause of the menstrual cycle.
• Increased prolactin levels cause breast engorgement and breast milk production.
• Increased sympathetic system activation can explain the sensation of fetal movements and feelings of labor pains at the expected date of delivery.
• Chronic contraction of the diaphragm is believed to be the major cause of the swelling of the abdomen. The muscle relaxes as soon as patients realize they are not pregnant, and the abdomen returns to its normal size.
The urine HCG pregnancy test will be negative in pseudocyesis. An Ultrasound scan will help the doctor to exclude true pregnancy and diagnose this condition.
The patient should be educated by gently breaking this bad news. They should be supported by psychological therapy to recover from disappointment.
Sources: https://www.ncbi.nlm.nih.gov/pmc/arti...
https://www.webmd.com/baby/false-preg...

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