Dysphoric Milk Ejection Reflex Explained: A Guide for New Moms

A lot of women believe that breastfeeding will cause plenty of warm and fuzzy sensations as mom and baby slide into nursing paradise. But the harsh reality for a small number of women is quite the opposite. Just imagine a situation where negative thoughts and feelings come to mind at the time of breastfeeding, and the emotions of Mommy seem to disappear forever from the memory. In the case of some moms, this is 100% possible, and it’s not postpartum depression. It’s a very different disorder called dysphoric milk ejection reflex, or D-MER.

What Is D-MER?

Dysphoric milk ejection reflex, or D-MER, is a condition that impacts a small subset of nursing women. It induces dysphoria, a sense of being unhappy for a few minutes, just before your breasts release milk. While it's true that D-MER has probably existed for decades, it was deeply studied in 2007 when a lactation consultant, Alia Macrina Heise, noticed she was having intense adverse feelings while nursing her third child.

She started doing research on it and found that some other women, too, have the same kind of symptoms. Since then, there have been only a few articles published in the newspaper on D-MER, and even now, many physicians are unaware of it, yet a survey revealed that approximately 9% of new mothers have it. Well, it’s not harmful, but it can be so unpleasant that it can make you give up breastfeeding entirely.

Typical Symptoms of D-MER

D-MER generally causes anxiety, depression, and anger. Every mother can encounter it in a different way, but the key traits are bad and undesirable feelings. The following are some additional symptoms that many moms have reported:

• Hopelessness
• Suicidal thoughts
• Feeling nervousness or paranoia
• Self-hatred
• Feelings of terror or a sense of looming threat
• Anger or agitation
• Feeling homesick or sad

The degrees of these symptoms can vary from mild to severe. They usually happen at the start of breastfeeding and can last as long as 10 minutes. Also, D-MER can have the same symptoms as postpartum anxiety and postpartum depression.

Causes of D-MER

Nothing is certain as of now, but it’s considered to be the result of 2 hormones, oxytocin and prolactin, that are discharged during breastfeeding. Prolactin is the one that helps the body to make milk, while oxytocin helps in the release process. Oxytocin is released immediately after your baby starts suckling or you start pumping with a bra like the Skye Pump Bra, in small amounts for the first 10 minutes. On the other hand, prolactin is released at a slower rate for about 20 minutes after you begin breastfeeding.

Once oxytocin is circulated, it blocks dopamine, a brain hormone and neurotransmitter that helps improve and normalize the mood. Normally, dopamine drops to a great extent and lactating mothers do not notice it, but in females with D-MER, it drops quicker than usual, which triggers a short wave of distress. This is only temporary, though, as your prolactin levels rise and your dopamine levels return.

Diagnosis of D-MER

There is no official diagnosis of dysphoric milk ejection reflex at this point, and it does fall under the category of postpartum mood disorder. Plus, there are no such diagnostic tests to check if you have it or not. Ideally, your symptoms and their occurrence will give you a hint that you’re experiencing it. If there is even the slightest possibility of having D-MER, consult with your doctor or medical practitioner. Another option is to talk to a lactation consultant, who might be more versed in managing this type of disorder.

Coping Strategies for D-MER

As we don’t know the exact cause and diagnosis of D-MER, there are no approved drugs to manage it, but there are a few coping strategies that may help many mothers. It is simple to keep perspective and deal with the experience when you are mindful that you are suffering from D-MER. Doctors who claim that stress and trauma complicate dysphoric milk ejection reflex suggest de-stressing strategies. Below are the most common things you can do:

• Making skin-to-skin contact with your toddler
• Having a massage
• Listening to soothing music
• Applying a heat pad around your shoulders
• Dipping your feet in mild, warm water
• Engaging in mindfulness and meditation activities
• Doing breathing exercises to calm the body and mind
• Spending time with your family and friends

It’s an interesting fact that some mothers have found some relief by taking Wellbutrin (bupropion). But there is no scientific evidence. Last, wear nursing bras and maternity bras. They do not have any relation with treating D-MER, but they are great for your well-being.

By and Large

Dysphoric Milk Ejection Reflex (D-MER) is real and more prevalent than you can imagine. As a first-time mother, if you're also feeling waves of sadness or anxiety during breastfeeding, don’t think you’re broken and it’s in your head. Support is out there. Brands like Lovemere, which support mothers through pregnancy, postpartum, and breastfeeding by offering maternity wear, are also helping to make mothers aware of conditions like D-MER with the help of blogs. Because with the right knowledge and support, motherhood can be way better.