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Dysphoric Milk Ejection Reflex (D-MER)

Negative emotions that occur with your let-down reflex.

Yes, it’s a real thing and help is available.

words
D-MER is a rare condition which some breastfeeding women experience. 
  • D = Dysphoria - a state of dissatisfaction, anxiety, restlessness or fidgeting 

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

Women with D-MER feel negative emotions seconds before their let-down reflex. It happens when they are breastfeeding or expressing and can also happen if their breasts let down at times when they aren't breastfeeding.  

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

Feelings associated with D-MER

Women use many different words to describe the feelings that happen with D-MER. Some of the most common are: 

  • Hollow feelings in the stomach 

  • Anxiety 

  • Sadness 

  • Dread 

  • Introspectiveness 

  • Nervousness 

  • Anxiousness 

  • Emotional upset 

  • Angst 

  • Irritability 

  • Hopelessness 

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

Symptoms of D-MER may decrease by 3 months after the birth or they may keep going for as long as the mum is breastfeeding. However how long it lasts, most mums do find that D-MER seems to get easier to manage as their baby gets older. 

What causes D-MER?

The current theory is that D-MER occurs as a result of inappropriate activity of a hormone, dopamine, when the let-down reflex is triggered. Research is being done to find the specific way in which D-MER occurs. 

Treatment

If you are experiencing D-MER, you may like to get advice and support from your doctor. In mild to moderate D-MER, lifestyle changes can help. You may find that just knowing your feelings have a name, helps you cope with the symptoms.  

Other things that may help are: 

  • distracting yourself while breastfeeding, eg eating  

  • avoiding things which make the symptoms worse such as stress, dehydration and caffeine  

  • prioritising sleep over less important activities. Lack of sleep makes symptoms of D-MER worse for some women. 

If your D-MER is severe, your doctor may discuss the use of a specific medicine or herbal product.  

For further information 

Visit: www.D-MER.org 

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.

References

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

Heise AM, Dysphoric milk ejection reflex (www.D-MER.org)

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.

© Australian Breastfeeding Association April 2022