By Ali Weatherford

The name of this condition, Dysphoric Milk Ejection Reflex (D-MER) is a mouthful, but actually does a really good job of describing it.

What is Dysphoric Milk Ejection Reflex?

Dysphoric means “unhappy, uneasy, or dissatisfied”. Milk ejection is when milk is released from the breast. Contrary to what a lot of people imagine, there isn’t a big pool of milk in the breast just waiting to be drawn out. When the baby attaches to the breast and starts trying to get milk out, it stimulates the body to produce some milk and then release it. That’s why a breast pump has the stimulation phase before it starts pumping more strongly. The goal is to simulate the suckling a baby does at first which is what triggers the milk to be let out. It doesn’t usually take long, but it’s part of the process.

Once that is working, the milk will “eject”. It might come out very strongly and even spray forcefully. This may happen more than once during a breastfeeding session. As the baby finishes the milk produced the first time, they can continue to suckle if they are still hungry, and that can create another “let down” of milk. That milk ejection sometimes creates a feeling of dysphoria in the breastfeeding parent. This is a very rare condition, occurring only in about 5-9% of lactating people.

So what that looks like in real life is that a breastfeeding person feels intensely bad for at least a few minutes while breastfeeding. It usually starts right as the milk ejection reflex is triggered and continues for a few minutes, but often not the whole duration of breastfeeding.

For some people, it will come back each time the milk ejection reflex is triggered, and for others it does not. People might describe feeling very sad or depressed or having a hollow feeling in the stomach. Others describe feeling disgust, dread, anxiety, irritability, nervousness, or even panic. Whatever it is, it is a very intense emotion that comes on very suddenly.

This condition is still relatively unknown, and many people believe they have postpartum depression. If they figure out the association with breastfeeding, they may just assume that they don’t like breastfeeding. Many people stop breastfeeding because of it. It can be extremely distressing, and most care providers don’t know what it is or how to help.

What Happens with This Condition?

There are a lot of theories as to why it happens. From a psychological perspective, some believe that it has to do with a person’s perception of the body, the breasts, and sexuality. It can be an uncomfortable shift to start thinking of the breast as a feeding tool for your baby when it is a body part that is oversexualized in our culture. If this is true for a person, it can be uncomfortable to breastfeed, but the emotional reaction is not usually as intense or sudden as D-MER.

There are also some good theories that blame the condition on a more physiological process, usually involving hormones. There are many hormones involved in making lactation work. Oxytocin and prolactin are the main ones we hear about. Prolactin mainly works to make milk, and Oxytocin mainly functions to release the milk. Oxytocin is also responsible for bonding and positive feelings, so typically breastfeeding results in lower stress and anxiety levels, better moods, lower rates of postpartum depression, and more ease in bonding.

But there are other chemicals involved in making it all happen, or that are affected by those hormone levels. Sometimes things just don’t work quite as we would expect them to. One of the prevailing theories related to D-MER is that a neurotransmitter called dopamine is somehow involved. Dopamine is a feel good chemical. Dopamine levels are affected by oxytocin and prolactin and vice versa. For prolactin to be abundant, dopamine levels need to be lower because dopamine holds prolactin back. The theory is that with D-MER there is a more abrupt but brief drop in dopamine when the milk release is triggered. It’s not understood why this happens for some people, but it’s most likely due to some complicated chemistry.

The good news is that D-MER is usually temporary. For most people, this improves after about three months. For others it continues to six or even 12 months. In other cases it doesn’t go away until weaning is complete. You don’t even have to be actively breastfeeding for this to happen. It can happen while pumping or even when the milk ejection reflex is triggered by something else like hearing a baby cry.

How to Help

One thing that helps for sure is knowing what is happening. When someone learns about D-MER, they usually feel a lot better about their situation and it becomes more manageable. It’s good to understand that it’s a physiological process and that it will go away after a brief period of discomfort. It helps to know that it’s not because you hate breastfeeding or feel negatively about your baby. In fact, something really interesting about D-MER is that the breastfeeding parent is usually very well bonded to their baby and enjoys their baby at all other times. It can take some time to understand that the negative feelings are only connected to those minutes after the milk ejection. This way of thinking about it helps a lot of people manage the symptoms with less distress.

It can also be helpful to start making breastfeeding as positive as possible. Ensure that you are surrounded by positive supportive people, get a massage, listen to enjoyable music, have a snack you really like. Setting up positive associations with breastfeeding as much as possible can help minimize the negative emotions experienced with D-MER.

You might also start using some mindfulness techniques such as meditation and breathing exercises. The goal is to stay rooted in the present moment, recognizing that you are OK and so is your baby. Focus on the health of your body and good posture and breathing. Recognize that this moment will pass more quickly as you continue to breathe well and stay connected to the fact that you and your baby are healthy and safe.

There is some evidence showing that people might get relief with using certain medications that affect dopamine such as bupropion and pseudoephedrine medications. These drug therapies have not been largely tested or approved for this use, but there are case studies showing they might be effective for some people. If D-MER is causing a big problem for you, it might be worth talking to a doctor about the condition and seeing about medication options. However, it can be difficult to find a provider who recognizes this condition and knows about treatment options.

Breastfeeding is such an important and empowering thing to do, and many people will work through anything to continue. It’s so important to also recognize that your good mental health is critical for you and your baby. If D-MER is extreme and might be keeping you from having a healthy relationship with your baby or postpartum recovery, please seek help. In many cases, it can be improved, and in other cases it may make sense to discontinue or minimize breastfeeding.

Most lactation consultants are familiar with this condition, and can provide some guidance and support. In many cases, just the validation and reassurance you can get from visiting with a caring provider can be enough to lower your stress levels and minimize your symptoms.

Resources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126760/
https://connect.springerpub.com/highwire_display/entity_view/node/67973/full
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594038/

Our articles are not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment.

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