What to Know About Dysphoric Milk Ejection Reflex (D-MER)

Do you feel sad upon let-down when pumping or breastfeeding? You may have D-MER.

You've heard about the benefits of breastfeeding (from the antibody boost for baby to the oxytocin surge for mom, as well as the bonding enhancement for the mother-infant dyad but nursing, albeit natural, does not come easily for many moms. Most often, these challenges stem from trouble latching to managing milk supply. While lactation classes and counselors can help to overcome these challenges, there is one often overlooked & underdiagnosed condition that is not as easily resolved with traditional lactation support and tools. It’s called D-MER, Dysphoric Milk Ejection Reflex.

Dysphoric Milk Ejection Reflex, also called D-MER, is a condition that affects 10% of new moms. It is characterized by a massive surge of negative emotions just before let-down or milk ejection. Rather than the typical mood boost that comes with let-down from the release of oxytocin, moms are filled with dread, panic, and even nausea.

Although it is not conclusive, some research suggests this happens as a result of a drop in dopamine when milk is ejected. It is thought to be a physiological reflex rather than a psychological response and differs from postpartum depression.

Here are a few of the most common symptoms of D-MER in new moms:

• A rush of negative emotions just before let-down (i.e. when milk is released), lasting a few minutes and up to 10 minutes.
• Because it happens during let-down, it happens during breastfeeding & pumping.
• Feelings are characterized by restlessness, general unease, sadness, anxiety, panic, anger, or agitation.
• For some women, it happens with every milk release, whereas with others it’s just for some feedings.
• D-MER tends to be strongest during the initial breastfeeding period, however, some moms experience it during the entirety of their breastfeeding/pumping journeys.

While the negative surge associated with D-MER is temporary and intense, there are often longer-term consequences on a new mom’s mental and emotional well-being. Feelings of guilt, inadequacy, and shame can persist throughout (and even beyond) the breastfeeding period. Below, you can hear from a patient who suffered from D-MER after the birth of her two sons.

Currently, there is no treatment for D-MER, and without the right support, many D-MER sufferers wean early as it is the only way to eliminate all symptoms of D-MER. However, there are some easy but impactful things that a new mom can do to mitigate and soothe her D-MER symptoms.

• Know that D-MER is a real diagnosis. Many mothers report that they are able to tolerate the symptoms of D-MER – and evidence suggests they are less likely to wean prematurely – when they understand that it is not their fault, but rather a physiological response they have no control over. Consider talking to a lactation consultant about your feeding experience or reaching out to D-MER support groups on social media so that you feel less alone.
• Engage in self-care techniques to use during pumping/ nursing. While a diagnosis is found to be the most helpful first step for D-MER sufferers, moms with the condition have shared that the following has helped them find emotional relief and cope during the intense negative surge while nursing or pumping:
  • Practicing Deep Breathing
  • Engaging in Visualization Techniques
  • Listening to Relaxing Music
  • Meditating
  • Soaking Feet in Warm Water

For others, sharing their experience with others or journaling can be therapeutic.

Claire experienced D-MER after the birth of each of her two sons. She shares what the experience was like, how she coped, and how it still impacts her today, even after weaning both boys.

“Even though the physical sensation of sadness passes, your memory of that persists... It was really helpful to hear that other women were struggling with breastfeeding. There’s so much power in knowing you’re not alone. It reduces the shame.” – Claire, Mother with D-MER.

To hear more of Claire’s story, download the Canopie app here or visit canopie.app with FREE access using the code DMER. Canopie is a digital app that offers evidence-based, personalized programs for expecting and new moms to soothe anxious minds, reduce stress, and boost mood.