Dysphoric Milk Ejection Reflex

mom breastfeeding baby

Cropped image. Cheryl, Flickr. CC license.

What is Dysphoric Milk Ejection Reflex (D-MER)?

D-MER is a condition affecting lactating women that is just recently been recognized. It is characterized by abrupt dysphoria, or negative emotions, that occur just before milk release. This reaction to letdown may occur when pumping, breastfeeding or when experiencing spontaneous letdown (i.e., milk releasing when not breastfeeding/pumping).

Moms have used many different words to explain the feelings that take place with D-MER. Some of the most frequent descriptions are anxiety, sadness, dread, nervousness, emotional upset, irritability and hopelessness.

D-MER presents itself with slight variations depending on the mother experiencing it, but it has one common characteristic: a wave of negative emotion just prior to letdown. This emotional response is the consistent key component in D-MER. The breastfeeding mother experiences a surge of negative emotions 30 to 90 seconds prior to her milk release when breastfeeding, pumping, or with spontaneous letdown.  It can last for a few seconds at the beginning of a feeding or it can happen repeatedly with multiple letdowns in the same feeding.

For some mothers D-MER is gone by the time the baby is 3 months old, but for other moms it lasts until weaning.

What is the cause of D-MER?

Before discussing what it is, it is important to discuss what it is not.

  • It is not a psychological response to breastfeeding.
  • It is not postpartum depression or postpartum mood disorder.
  • It is not general dislike of breastfeeding.
  • It is not breastfeeding “aversion”.
  • It is not due to a history of depression, a history of physical/sexual abuse.
  • It is not related to the mother’s birthing experience.
  • It is not because she doesn’t love her baby enough or because she’s a bad mother.

Other important things to note:

  • Mothers themselves cannot cause D-MER. It is a hormonal problem.
  • The feelings a mom experiences with D-MER are not real. They are her hormones are fooling her and even though it feels like it’s in her head, it’s not.
  • Mom did nothing to cause it, and she cannot make herself snap out of it

Research tells us that D-MER is physiological not psychological. This means that hormones in the mom’s body, not past experiences or repressed memories, that are causing the condition.

Preliminary studies found that D-MER is the result of the drop in dopamine levels at letdown. This drop must occur to allow the prolactin (milk-making hormone) level to increase. This happens to all mothers, but in women with D-MER, the dopamine level drops too far or too fast in the central nervous system. This results in a wave of negative emotions.

What treatment is available?

For mothers with mild to moderate D-MER, education may be the best treatment. Many women find their symptoms are more easily managed once they are aware it is a medical problem and not an emotional one. Tracking symptoms in a log and learning what makes them better or worse is helpful for many moms.

Mothers with more severe D-MER are encouraged to visit their health care provider. Together, they can determine the best way to treat this condition effectively. So far, it has been proven that medications that increase dopamine levels in a mother can treat D-MER effectively. The best way to receive the proper treatment is to let your doctor know exactly what is happening when you experience these feelings.


D-MER is not a new condition, but until recently, little was known about it. Many mothers were embarrassed to talk about this; they thought they were the only ones struggling with the feelings they had during letdown. If they did speak of it, many times a mother’s feelings were dismissed. We are just discovering how widespread this is. As more people continue to speak up about this condition and awareness increases, progress will continue to be made in the education, support and treatment of D-MER.

– Pat Ashley, RN, IBCLC, Beaumont Hospital, Grosse Pointe

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