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Absence of menstruation can be caused bychronic illness,by emotional or endocrine disturbances, by fear of pregnancy, or by a desire to be pregnant. Nausea and vomiting may beof gastrointestinal or psychic origin. Tenderness of the breasts can bedue to a hormonal disturbance.

Any condition that causespelvic congestion, such as apelvic tumour, may cause duskiness of the genital tissues. At times a soft tumour of the uterus may simulate a pregnancy. The question of pregnancy may be raised if the woman does not menstruate regularly; the absence of other symptoms and signs of gestation indicates that she is not pregnant.

There arerare ovarian and uterine tumours that producefalse-positive pregnancy tests.It may be difficult for the physician to exclude pregnancy on the basis of an examination if the uterus is tipped back and difficult to feel, or if it is enlarged by a tumour within it. If other signs of pregnancy are absent, however, and the tests for pregnancy are negative, pregnancy can most likely be ruled out.

Childless women who greatly desire a baby sometimes suffer fromfalse or spurious pregnancy (pseudocyesis). They stop menstruating, have morning nausea, "feel life," and have abdominal enlargement caused by fat and intestinal gas. At "term" they may have "labour pains." Signs of pregnancy are absent. Treatment is by psychotherapy.

Menopausal women often fear pregnancy when their periods stop; information that they show no signs of pregnancy usually reassures them. Retained uterine secretions of bloody or watery fluid, caught above a blocked mouth of the uterus (cervix), prevent menstruation, cause softening and enlargement of the uterus, and may cause the patient to wonder whether she is pregnant.

There are no other signs of pregnancy, and the hard cervix, closed by scar tissue, explains the problem.

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