What Is D-MER? I Truth Behind Dysphoric Milk Ejection Reflex

Dysphoric milk ejection reflex, or D-MER, is a physiological condition causing breastfeeding mothers to experience negative feelings or emotions at, or just before, the time of their milk ejection reflex (when their milk ‘lets down’).

There is limited research and poor public awareness about D-MER, however, which leaves many mothers feeling confused about their experience.

In order to understand the truth behind Dysphoric Milk Ejection Reflex, it is helpful to know exactly what a milk ejection reflex is.

The milk ejection reflex or ‘let-down’ reflex

The milk ejection reflex occurs when a breastfed baby begins to suckle at her mother’s breast. The nerve endings in the nipple respond to the baby’s suckling by sending a message to the brain to release oxytocin.

This release of oxytocin causes the milk-making cells to contract and the ducts in the breast to widen, pushing milk down towards the nipple, where it becomes available to the baby. Several milk ‘let-downs’ occur during breastfeeding sessions, although the breastfeeding mother usually feels the first milk ejection the most intensely.

When their milk lets down, some women describe the feeling as a tightening, tingling or ‘pins and needles’ feeling in the breasts; others experience no sensation at the time of milk release.

What causes dysphoric milk ejection reflex?

Although the exact cause of dysphoric milk ejection reflex is not completely understood, it is believed that D-MER is a hormonal reaction to an abrupt drop in dopamine levels, which occurs in conjunction with the release of oxytocin and milk ejection reflex. This results in a real and relatively brief dopamine deficit for affected women.

Symptoms of dopamine deficiency can include anxiety, depression and feeling of hopelessness. The symptoms vary in severity, depending on the condition underlying the deficiency. Dopamine deficiency is not a diagnosis on its own.

More research on human lactation is required to understand why dysphoric milk ejection reflex occurs in some lactating women and not in others, and to provide information to health care providers about how to support mothers who have this condition.

What are the symptoms of dysphoric milk ejection reflex?

Symptoms of D-MER can range from mild to unpleasant emotions to intense, negative feelings of dread.

In a case report on dysphoric milk ejection reflex in the International Breastfeeding Journal, a mother described her symptoms of D-MER as feeling helpless, hopeless and worthless just before each milk release. These feelings were not only experienced with milk releases while breastfeeding, but also associated with expressing milk or with spontaneous milk ejection between feeds. Between each milk ejection reflex she reported feeling happy and well bonded to her baby. This was her first experience with D-MER, even though it was her third baby.

In other maternal experiences, D-MER symptoms have been described as:

  • Sadness
  • Unpleasant or uncomfortable mood
  • Low self esteem or self hate
  • Anger, agitation or irritability
  • Paranoia
  • Loss of concentration
  • Anxiety or churning stomach.

Recent research appears to suggest that once a mother has experienced D-MER with her breastfed baby, she is more likely to experience it with subsequent children. This could be due to a predisposition to abnormal dopamine activity, but the reason isn’t entirely clear.

Is dysphoric milk ejection reflex associated with postpartum depression?

The word ‘dysphoria’ describes a state of feeling very unhappy or uneasy. There are several mental health conditions associated with dysphoria, such as premenstrual dysphoric disorder (PMDD), or body dysphoric disorder (BDD).

These conditions differ from D-MER, as the key defining symptom of D-MER is the brief negative emotions experienced by a breastfeeding mother associated with the specific timing of the milk ejection reflex. They can last from 30 seconds to 2 minutes, and are not felt at other times. This is different from the experience of suffering postpartum depression (sometimes called postnatal depression) or postpartum mood disorder, where a mother might frequently experience negative thoughts or emotions.

Dysphoric milk ejection reflex has been identified as a physiological reaction, not a psychological response, to breastfeeding. A breastfeeding mother’s medical history and disposition are not indicative of the likelihood of her experiencing the intense negative emotions associated with D-MER.

For more information on postpartum depression, you can read BellyBelly’s article Postpartum Depression Symptoms | 9 Signs You Have PPD.

Can D-MER affect breast milk supply?

Although D-MER symptoms can cause intense feelings in conjunction with milk release, the condition is generally not known to affect breast milk production or breast milk supply.

Many parents report that having D-MER diagnosed elicits a feeling of relief to find that there is an explanation for the symptoms or negative emotions they have been experiencing.

In most cases, this allows breastfeeding parents to continue their breastfeeding journey while managing their symptoms of D-MER.

Strategies to help with the negative emotions associated with D-MER

If you you think you could be suffering from D-MER, seek advice from a breastfeeding counselor from the Australian Breastfeeding Association or La Leche League International, or from a certified lactation consultant.

You can try these strategies, which might help manage symptoms of D-MER:

  • Eat a diet high in magnesium, tyrosine and omega-3 fatty acids
  • Have regular skin to skin contact with your baby
  • Try yoga, meditation or other activities that focus on deep breathing
  • Join an online support group.

You can also talk to your health care provider about taking additional supplements, such as vitamin D, as research has found vitamin D deficiency can affect dopamine release mechanisms.

For more information on breastfeeding and vitamin D, you can read BellyBelly’s article Vitamin D While Breastfeeding | Why It Is So Important.

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