Dysphoric Milk Ejection Reflex (D-MER)

What Is D-MER?

D-MER is a condition where a woman experiences negative emotions right before their let-down reflex (a reflex which causes breastmilk to flow). D-MER is not a well known condition and not spoken about much, so it can come as a surprise when women experience these emotions during breastfeeding, leaving them wondering what is going on. Some women might wonder if they have postpartum depression or anxiety due to the nature of the thoughts and feelings, but it’s a very different condition. While D-MER is under-researched, it’s estimated to affect around 9% of breastfeeding women, although researchers suspect it’s actually higher than this. D-MER usually goes away on it’s own before 3 months, but for some women it can last longer.

Symptoms Of D-MER

Symptoms of D-MER are different among women, but some of the common symptoms that occur during the let down reflex include:

Hollow, churning feelings in the pit of the stomach
Anxiety
Sadness
Dread
Irritability
Hopelessness
Nausea
Negative thoughts, including towards your baby and breastfeeding
Thoughts of death and suicide

What Causes D-MER?

It’s not fully known why D-MER occurs, but one current theory is that it’s caused by the abrupt changes to a woman’s hormones during their let down. Basically, nipple stimulation (which occurs during breastfeeding) releases oxytocin – the hormone responsible for your let down. Oxytocin suppresses dopamine, so, for reasons not yet fully understood, some women’s dopamine levels drop extremely quickly right before their let down.

How To Manage D-MER:

Know there are other options

Unfortunately, there’s still a lot of shame and stigma associated with formula. Your mental health is important, and it’s up to you how you want to feed your baby – nobody else. If you want to continue to breastfeed and manage D-MER, great. If you don’t, great. Formula is a safe and available alternative.

Plan for your let-down

The change in hormones that lead to D-MER don’t last long. They are temporary and you’ll be feeling back to normal really soon. Knowing they are about to come, why they are happening, and reminding yourself they are also going to go soon, can be a really helpful tool in itself.

Relaxation and Mindfulness

Having a relaxing place where you can go to breastfeed, away from triggers, can help. Whether it be other kids, the dog barking, or the sound of the TV – find a place where all these things are minimised. Once you’re free from any triggers, engage in some relaxation techniques or mindfulness, which can help to manage the negative emotional response. Deep breathing, grounding, a hit of lavender – whatever works for you, use it.

Skin to skin

Having skin to skin contact can help to manage the physiological response of the abrupt hormonal change. Skin to skin promotes dopamine – helping with the rapid drop in dopamine which is said to cause D-MER, and while it also releases oxytocin, it does so in a more gradual way.

Distraction

We don’t promote distraction as a tool to manage your mental health ALL the time, but it certainly has its place. It has even more of a place with D-MER because it’s caused by a physiological response, not a psychological one. D-MER will go away on it’s own soon, so using avoidance strategies, like distraction, won’t do much harm. Pop on a podcast when you start a feed, text a friend, have something to eat, do a Sudoku – whatever gets your mind off it.

Our experienced team can discuss your concerns - contact us to learn more.

Dysphoric Milk Ejection Reflex (D-MER)