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Dysphoric Milk Ejection Reflex (D-MER)


What is D-MER?

D-MER is a rare condition which can affect some breastfeeding women.

D=Dysphoria which is defined in the Macquarie Dictionary as a state of dissatisfaction, anxiety, restlessness or fidgeting

MER= Milk ejection reflex (the ‘let-down’)

D-MER is characterised by negative emotions, that occur seconds before a mother’s milk ejection reflex when breastfeeding or expressing or with a spontaneous MER (ie milk releasing when not breastfeeding or expressing).

D-MER is very different from Postnatal Depression (PND) or an anxiety disorder. D-MER is associated with negative emotions only with a MER.

Feelings associated with D-MER

Many different words are used to explain the feelings that take place with D-MER. Some of the most frequent are:

  • Hollow feelings in the stomach
  • Anxiety
  • Sadness
  • Dread
  • Introspectiveness
  • Nervousness
  • Anxiousness
  • Emotional upset
  • Angst
  • Irritability
  • Hopelessness
  • Something in the pit of the stomach.

One mother’s experience of D-MER

If you have read Harry Potter they talk about the creatures that suck the soul out of you and when they are around it makes you cold and you start to focus on negative things and fall into this abyss of negative thoughts — that is how D-MER was for me at times.

 What causes D-MER?

The current theory is that D-MER occurs as a result of inappropriate activity of a hormone, dopamine, when the MER is activated. Research is currently underway to determine the specific mechanisms involved with D-MER.


Some mothers with D-MER have mild symptoms. For example they may describe it as a ‘sigh’. Other mothers with D-MER may experience severe symptoms of D-MER (eg suicidal or thoughts of self-harm).


Symptoms of D-MER may decrease by 3 months postpartum or they may continue throughout the breastfeeding period. Regardless of how long it lasts, most mothers do find that D-MER seems to get easier to manage as their baby gets older.


Mothers with D-MER are encouraged to seek advice/support from their doctor. In mild to moderate D-MER, lifestyle changes are often helpful. For some women, being aware of what D-MER is helps them cope with the symptoms. Distraction helps some women cope with the condition too (eg eating while breastfeeding). Also, avoiding factors which may worsen the symptoms (eg stress, dehydration and caffeine) can help some women. Lack of sleep makes symptoms of D-MER worse for some women and so prioritising sleep over less important activities can help some women too. For mothers with severe D-MER, a doctor may discuss the use of a specific herbal supplement or medication.

For further information



Cox S, (2010), A case of dysphoric milk ejection reflex (D-MER). Breastfeeding Reviewe, 18(1):16–18.

Heise AM, Dysphoric milk ejection reflex (

Stacey AJ, (2020), Dysphoric milk ejection reflex. Breastfeeding Review, 28(1): 29–32.

Heise AM, Wiessinger D, (2011), Dysphoric milk ejection reflex: A case report. International Breastfeeding Journal, 6(6):1–6.

The information on this website does not replace advice from your health care providers.

© Australian Breastfeeding Association December 2018

Last reviewed: 
Dec 2018