D-MER is a condition experienced by some breastfeeding women. It is a negative emotional or mood change that occurs in tandem with the milk ejection reflex.
What happens during D-MER?
D-MER has been reported to last for a few minutes and to occur just before / during the milk let down when breastfeeding or expressing.
Descriptions of how D-MER feels have varied between women, with some experiencing mild responses and others more severe. Women report feeling:
- Sadness
- Dread
- Anxiety
- Hopelessness
- Nausea
- Exhaustion
- Frustration
- Irritable
- Agitated
Is it common?
The incidence of D-MER has not been well researched globally; however, some groups have attempted to quantify rates of this condition within their facilities. One study reports a rate of 6% and another reports 9%.
Is it associated with other mood conditions?
One study reported increased incidences of D-MER in women who had previously been diagnosed with mood disorders such as bipolar and schizophrenia, however, this was in a relatively small sample size.
Interestingly, women who showed symptoms of D-MER were more likely to score higher on depression scales and to score lower on a scale measuring breastfeeding self-efficacy. Researchers comment on the ability of D-MER to impact feelings and mood, even after the initial reaction has resolved.
The research also reports how D-MER impacts women’s relationship with breastfeeding. Creating feelings of aversion, isolation, and shame around how they now feel about breastfeeding. For some, D-MER contributed to reduction or cessation of breastfeeding.
Why does it happen?
A thorough understanding of D-MER and why it occurs is not yet available. Much more research is needed on the condition and the potential causes and effects.
It is believed that D-MER is linked to hormonal fluctuations, given that breastfeeding is governed by and impacts hormones. The milk let down reflex occurs in response to oxytocin being released. Dopamine has been noted to fall in response to the release of prolactin, which occurs in tandem with oxytocin release to initiate further milk production. However, the exact modulations of hormones and how they create the responses experienced during D-MER are not fully understood.
What can I do if I’m experiencing D-MER?
The first thing is to continue reading from reliable evidence based sources until you feel you understand the condition as much as possible. This might help you identify the elements you can control and those you may need support with.
A review of the literature reported that all studies found symptoms decreased in severity over time. Other research groups have reported some women found the condition to feel more manageable after learning about it and improving their understanding of what they were experiencing.
It has been reported that distraction during let downs can help reduce symptoms, and improving sleep and hydration is also reported to be helpful. Further to this, support from peers and validation from a support network has been reported to help women with D-MER.
If you feel it is significantly impacting your breastfeeding or health, reach out to your GP and / or lactation consultant for extra support.
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. Front Glob Womens Health, 2, 669826. https://doi.org/10.3389/fgwh.2021.669826
Lynn Herr, S., Devido, J., Zoucha, R., & Demirci, J. R. (2024). Dysphoric Milk Ejection Reflex in Human Lactation: An Integrative Literature Review. J Hum Lact, 40(2), 237-247. https://doi.org/10.1177/08903344241231239
Morns, M. A., Steel, A. E., Burns, E., & McIntyre, E. (2021). Women who experience feelings of aversion while breastfeeding: A meta-ethnographic review. Women and Birth, 34(2), 128-135. https://doi.org/https://doi.org/10.1016/j.wombi.2020.02.013
Nguyen, L., Stokes, S., Alsup, K., Allen, J., & Zahler-Miller, C. (2024). Dysphoric Milk Ejection Reflex: Characteristics, Risk Factors, and Its Association with Depression Scores and Breastfeeding Self-Efficacy. Breastfeed Med,19(6), 467-475. https://doi.org/10.1089/bfm.2023.0241
Ureño, T. L., Berry-Cabán, C. S., Adams, A., Buchheit, T. L., & Hopkinson, S. G. (2019). Dysphoric Milk Ejection Reflex: A Descriptive Study. Breastfeed Med, 14(9), 666-673. https://doi.org/10.1089/bfm.2019.0091
