Understanding Dysphoric Milk Ejection Reflex (D-MER): Causes, Symptoms, Treatment, and Coping Strategies
- Loree Siermachesky
- Mar 14
- 7 min read
Updated: Mar 15
For many mothers, breastfeeding is a joyful and intimate bonding experience with their babies. However, for some, breastfeeding can trigger unexpected feelings temporarily related to the milk ejection release during lactation (Heise & Wiessinge, 2011). This lesser-known yet impactful condition is Dysphoric Milk Ejection Reflex (D-MER), which was first identified by Alia Macrina Heise in 2007 (Dief et al., 2021). While research is limited and the prevalence of D-MER is largely unknown understanding the causes, symptoms, treatment options, prevention strategies, and coping techniques can allow breastfeeding mothers affected with D-MER to find support and gain clarity on their breastfeeding journey.
What is Dysphoric Milk Ejection Reflex (D-MER)?
Dysphoric Milk Ejection Reflex (D-MER) is a condition that is characterized by sudden and intense feelings of dysphoria, a state of unease or discomfort, that occurs right before or during milk release (Heise & Wiessinge, 2011). The milk ejection reflex is the letdown process by which a mother’s milk is released from the breast, usually triggered by the baby’s sucking (Merenstein & Gardner, 2020). While most mothers experience a positive or even pleasurable feeling during this time, mothers with D-MER experience a sudden drop in mood, which can feel like anxiety, sadness, irritability, or even despair (Heise & Wiessinge, 2011). These negative feelings are usually brief and last only a few minutes but can reoccur multiple times during a breastfeeding or pumping session and have a significant emotional impact during each feeding (Heise & Wiessinge, 2011).
Causes of D-MER
The exact cause of D-MER is not fully understood, but a primary factor is hormonal fluctuations. When a mother breastfeeds, her body produces a variety of hormones, including oxytocin, the hormone responsible for milk letdown, and prolactin, which supports milk production (Heise & Wiessinge, 2011). These hormonal shifts can impact emotional regulation in some mothers, leading to feelings of distress.
Oxytocin’s role: Oxytocin is often called the "love hormone" because it plays a role in bonding, relaxation, and nurturing. During breastfeeding, oxytocin is released to trigger milk letdown. For mothers with D-MER, this release of oxytocin can cause a sudden and intense negative emotional reaction, as opposed to the usual feelings of warmth or relaxation (Heise & Wiessinge, 2011).
Dopamine’s involvement: Dopamine is a neurotransmitter that plays a role in mood regulation. Some research suggests that in women with D-MER, the dopamine response to oxytocin may be dysregulated, causing a “dopamine dip” right before milk release. This dip in dopamine levels may explain the emotional discomfort that characterizes D-MER (Deif et al., 2021).
Other potential causes: Genetic predisposition, past traumatic experiences related to breastfeeding, or a history of mental health issues may contribute to the development of D-MER in some individuals (Deif et al., 2021). In addition, D-MER can be more commonly seen in women with a history of anxiety or depression, although it is important to note that it differs from postpartum depression (Deif et al., 2021).
Symptoms of D-MER
The primary symptom of D-MER is a sudden feeling of dysphoria, which occurs just before or during milk letdown. This feeling typically lasts for a few minutes and may include one or more of the following:
Anxiety: An overwhelming sense of nervousness or fear that seems disproportionate to the situation.
Sadness or despair: Intense feelings of sadness or hopelessness that come and go quickly.
Irritability: An unexplainable sense of frustration or annoyance during breastfeeding.
Depersonalization: A feeling of being disconnected from one’s own emotions or body.
Physical symptoms: Some women report physical discomfort, such as nausea, dizziness, or a tightening in the chest.
It is important to note that these feelings are temporary and generally subside after a few minutes, once the milk letdown process is complete. However, they can be quite distressing, and many mothers may feel isolated or ashamed, especially since this condition is not widely discussed (Deif et al., 2021).
How D-MER Differs from Other Conditions
D-MER is often confused with postpartum depression (PPD) or postpartum anxiety (PPA) because of its emotional symptoms. However, there are important distinctions:
Timing: D-MER is tied directly to breastfeeding and the milk letdown reflex. It happens only during or just before feeding and resolves shortly afterwards. In contrast, postpartum depression may persist for weeks or months, with symptoms affecting a mother’s mood and daily life (Deif et al., 2021).
Nature of the feelings: The feelings of dysphoria in D-MER are brief and usually fade after the milk release. They are typically not as persistent or debilitating as the symptoms of depression or anxiety disorders (Deif et al., 2021).
Another condition that may be confused with D-MER is Breastfeeding Aversion and Agitation (BAA). This situation involves a dislike or aversion to breastfeeding, with emotions associated with discomfort, frustration, or even anger (Yate, 2017) However, lactational aversion tends to be more about the overall breastfeeding experience, whereas D-MER is directly tied to the hormonal and physiological process of milk letdown (Heise & Wiessinge, 2011). Some mothers experience both D-MER and BAA, at the same time, but they are different, distinct phenomena.
Treatment Options for D-MER
Currently, there is no one-size-fits-all treatment for D-MER, but several strategies may help alleviate symptoms.
1. Medication
In some cases, medications may be recommended to help manage the emotional symptoms associated with D-MER. These may include:
Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) are sometimes prescribed to help regulate mood and improve emotional well-being (Deif et al., 2013). These may be considered if the emotional symptoms of D-MER are severe or impacting daily life.
Dopamine regulators: As the dysphoria may be related to a drop in dopamine levels during letdown, certain medications that regulate dopamine levels may help mitigate the emotional reaction (Deif et al., 2013).
Vitamin Supplements: While there's no direct evidence that vitamin supplementation can prevent or treat D-MER, some mothers who experience D-MER have found that addressing vitamin D deficiency or supplementing with vitamin D has helped with their overall mood and anxiety, which in turn, may have helped with the experience of D-MER. Other nursing women found supplementing their diet with extra magnesium, vitamin B complex supplements and probiotics provided benefits with mild to moderate D-MER symptoms (Yate, 2017).
It is essential to consult a healthcare professional before using any medication or supplements, as some of these may interfere with breastfeeding or affect breastmilk supply.
2. Breastfeeding Management Techniques
Positioning: Experimenting with different breastfeeding positions may help reduce discomfort. Some mothers report that changing their position slightly helps with the emotional experience of breastfeeding.
Mindfulness: Practicing mindfulness techniques, such as deep breathing or progressive muscle relaxation, may help alleviate feelings of anxiety or discomfort when they occur during breastfeeding. This can be especially helpful for mothers who want to stay present and relaxed during feeding.
Milk Expressing: Some women find that expressing a small amount of milk before beginning a feeding helps to trigger the letdown reflex more gradually, potentially reducing the intensity of the emotional response.
3. Support Groups and Therapy
Joining a support group or seeking therapy can be incredibly beneficial. Talking with other mothers who have experienced D-MER or seeking professional help from a counsellor or therapist can help provide coping mechanisms and emotional support.
Prevention Strategies
There is no known method to prevent D-MER from occurring, but certain steps can help to minimize symptoms.
Pre-breastfeeding relaxation: Before breastfeeding, relaxing and focusing on your mental state can help lower overall stress levels. This can include gentle breathing exercises, listening to calming music, or practising meditation.
Self-care: Ensuring you get enough rest, nutrition, and support can help improve your emotional well-being and reduce the impact of D-MER symptoms.
Education and awareness: Understanding the condition is essential. Knowing that D-MER is temporary and physiological can help reduce feelings of isolation or guilt. Reaching out to healthcare professionals who are knowledgeable about D-MER can be empowering.
Coping with D-MER
Coping with D-MER can be challenging, but several strategies may help reduce the emotional distress it causes.
1. Create a Positive Breastfeeding Environment
Set up a comfortable, soothing environment for breastfeeding, which can help reduce stress. Have pillows for support, play calming music, or dim the lights to create a tranquil space to mitigate negative feelings.
2. Focus on the Bonding Experience
While the feelings of dysphoria can be difficult to handle, focusing on the bond with your baby can help shift your attention. Try to remind yourself that this experience is temporary and that the moments of discomfort will pass quickly.
3. Talk to Your Partner or a Trusted Person
Sharing your experiences with a supportive partner, friend, or family member can provide comfort and understanding. Sometimes, simply having someone to listen can alleviate feelings of isolation.
4. Gentle Self-Compassion
Practice self-compassion and recognize that your feelings are valid. D-MER is a real condition, and it’s okay to seek help and take care of yourself.
For mothers dealing with D-MER, it’s important to remember that the feelings of discomfort are temporary and not a reflection of your ability to breastfeed. By seeking support, exploring coping strategies, and managing the condition with the help of your healthcare providers, mothers can navigate this experience more comfortably. Awareness and understanding are key. No mother should feel ashamed or alone in her experience.
Parent Resources:
References:
Deif, R., Burch, E. M., Azar, J., Yonis, N., Abou Gabal, M., El Kramani, N., & DakhlAllah, D. (2021). Dysphoric milk ejection reflex: The Psychoneurobiology of the breastfeeding experience. Frontiers in Global Women's Health, 10(2), 1-8. https://pmc.ncbi.nlm.nih.gov/articles/PMC8594038/pdf/fgwh-02-669826.pdf
Heise, A.M. & Wiessinger, D. (2011). Dysphoric milk ejection reflex: A case report. International Breastfeeding Journal, 6(6),1-6. https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-6-6
Merenstein, G. B., & Gardner, S. L. (2020). Breastfeeding and Human Lactation. Jones & Bartlett Publishers.
Yate, Z. M. (2017) A qualitative study on negative emotions triggered by breastfeeding; Describing the phenomenon of breastfeeding/nursing aversion and agitation in breastfeeding mothers. Iranian Journal of Nursing Midwifery Research, 22(6), 449-454. https://pmc.ncbi.nlm.nih.gov/articles/PMC5684792/
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