Breastfeeding is often described as a time of closeness and bonding, but for some mothers, it can bring sudden, intense waves of sadness, anxiety, restlessness, or discomfort that seem to appear out of nowhere. These feelings are not your fault—they are a physiological response, not a reflection of your love for your baby or your ability to parent. Understanding the term Dysphoric Milk Ejection Reflex (D-MER) can help you recognize what’s happening in your body and feel less alone as you navigate this unexpected aspect of your breastfeeding journey.

What Causes D-MER?

D-MER is a condition in which negative emotions occur just before or during milk letdown. Unlike typical emotional fluctuations, these feelings are triggered by the physiological process of the release of milk, rather than a psychological response or postpartum mood disorder. D-MER is an area of lactation that has not been well researched; however, it is estimated that this condition affects about 9% of breastfeeding women. Researchers believe it is connected to the complex hormonal changes that occur during milk letdown, including fluctuations in prolactin and oxytocin levels impacting dopamine levels.

When a mother’s breasts are stimulated through breastfeeding or pumping, these hormonal shifts trigger the sudden and intense negative emotions or physical sensations that occur just before milk release. While the exact mechanisms are still being studied, understanding that these feelings are tied to natural hormonal changes can help mothers understand D-MER and its potential impact on feedings.

Understanding D-MER

Emotional Symptoms

Mothers with D-MER often report negative feelings during breastfeeding or pumping, including overwhelming sadness, anxiety, dread, or anger. These feelings can be particularly distressing because they feel disconnected from a mother’s usual emotional state and out of step with the loving bond she has with her baby.

The good news is that these intense emotions typically last only a minute or so during letdown and usually subside once milk flow stabilizes. It’s important to note that D-MER is not linked to postpartum depression (PPD) or anxiety, even though the sensations can feel similar. Because D-MER can sometimes be mistaken for postpartum mood disorders, working with both a mental health professional and a lactation consultant can provide guidance, reassurance, and the support you need to navigate this condition.

Physical Symptoms

In addition to the emotional effects, some women experience physical sensations alongside D-MER. These can include nausea or motion-sickness–like feelings, changes in heart rate, or sudden chills or shakiness. Like the emotional symptoms, these physical sensations usually last only a minute or two around the time of letdown during feeding or pumping sessions.

How Long Will This Last?

Research suggests that D-MER affects women differently over time. About 30% of women in studies reported that their symptoms resolved as breastfeeding continued, while roughly 40% experienced consistent symptoms from birth until weaning. Many participants who used exclusive pumping found it helped reduce the severity of symptoms, though a small number reported that pumping actually intensified them.

Things That Make D-MER Worse

The first step in managing D-MER is learning to identify what triggers or intensifies your symptoms. Many mothers find it helpful to keep a simple journal or use a feeding tracker app to note the timing of symptoms, their severity, and how long they last. Over time, these notes can reveal patterns that help guide your care and support.

  • Going too long between feedings or pumping sessions

  • High stress, poor nutrition, or sleep deprivation

  • Being in a cluttered, chaotic, or emotionally negative environment

  • Feeling overstimulated—especially by touch or being around others

  • Hormonal shifts, including menstrual cycle changes or hormonal birth control

  • Certain medications or herbs used to increase breast milk production

Things That May Improve D-MER

Emotional Symptoms

  • Practice stress-reduction techniques like deep breathing, mindfulness, or gentle relaxation exercises.

  • Listen to favorite music, an audiobook, or a podcast to give your mind a soothing distraction.

  • Build endurance by counting or singing to remind you how brief these episodes are.

  • Join a peer support group or connect with an emotional support person who you can chat with any time you feel overwhelmed.

  • Call in your helpers. For at least the first few weeks as you work to establish breastfeeding, ask someone to come sit with you during feedings to lessen the feelings of isolation or dysphoria.

Physical Symptoms

  • Sip on ginger tea or ginger candy to help ease nausea.

  • Use warmth—a heated blanket, heating pad, or hand warmer placed within reach before feeding can offer comfort.

  • Try a gentle fan blowing toward your face to counter feelings of motion sickness or claustrophobia sensations.

  • Sip ice-cold water for a refreshing distraction during letdown.

Does D-MER Impact Milk Supply or Successful Breastfeeding?

D-MER does not directly interfere with your ability to produce milk or feed your baby, whether you choose to breastfeed directly, rely on exclusive pumping, or a combination of the two. However, the discomfort—both emotional and physical—can have a negative effect on breastfeeding outcomes and lead some women to consider ending breastfeeding earlier than planned. Understanding your symptoms, exploring management strategies, and getting the right support can help you protect your well-being while continuing to meet your breastfeeding goals.

Professional Help

Work with a Lactation Professional

A lactation consultant can help you understand D-MER and offer strategies to manage the emotional and physical sensations you’re experiencing. They can also support you in working toward your breastfeeding goals—whether that includes direct breastfeeding, pumping, combo-feeding, or gradually transitioning away from breastfeeding.

Talk to Your Healthcare Providers

In some cases, medication, nutritional, or herbal supplements may be recommended to help manage D-MER symptoms. Because every situation is unique, it’s important to consult with your healthcare provider to determine what’s safe and appropriate for you.

Navigating D-MER doesn’t mean you’ve failed at breastfeeding or bonding—it means your body is responding in ways you couldn’t have predicted. With the right information and compassionate support, you can find a path that protects both your emotional well-being and your connection with your baby. You deserve care, understanding, and options that honor your whole experience.

Disclaimer: Our classes and accompanying materials are intended for general education purposes and should not replace medical advice. For personalized recommendations, please consult your healthcare provider and/or lactation consultant.