What To Know About DMER (Dysphoric Milk Ejection Reflex)

What To Know About DMER (Dysphoric Milk Ejection Reflex)

Written by: Wendy, IBCLC

After getting the hang of it, most of us hope that breastfeeding can be a cozy, warm, positive experience for mom and baby. But for some of us, breastfeeding can end up feeling like the exact opposite. Instead of happy feelings, you may be flooded with intense feelings of dread, sadness, irritation, and even anger.

If this is happening to you, especially if it happens soon after your milk lets down, you may be experiencing something known as DMER, or Dysphoric Milk Ejection Reflex.

WHAT IS DMER?

DMER is a physiological phenomenon that an estimated 9% of breastfeeding moms experience. It’s important to understand that DMER is a physical, bodily reaction to the hormones and mechanisms of breastfeeding and not something that the breastfeeding parent is making up. It’s not your fault if you are experiencing DMER.

Although research is ongoing, it’s thought that DMER happens as a result of the drop in dopamine that happens when your milk lets down. This drop is what causes the telltale symptoms, including:

  • Sadness
  • Depression
  • A sense of doom
  • Agitation
  • Restlessness
  • Anger
  • Anxiety
  • Panic
  • Dizziness

When identifying DMER, you should keep in mind that it’s all about the timing. DMER specifically happens when your milk lets down (when you experience a tingling feeling in the breasts that coincides with your milk flowing/baby gulping milk). These negative emotions will then sweep over you within a few seconds of letting down and then can last for a few minutes, no more than 10 minutes.

Usually, people who experience DMER feel normal between letdowns and between breastfeeding sessions. If you have pervasive feelings of depression or anxiety, you might be dealing with a postpartum mood disorder such as postpartum depression.

HOW CAN YOU COPE WITH IT?

One of the best ways to cope with DMER is to identify and acknowledge it. Part of what happens when you first experience DMER is that you start to worry about the feelings themselves and blame yourself for them, which can only make the experience worse! 

Knowing that DMER is a physiological phenomenon and not something that’s “in your head” is an important first step to being able to move through DMER more easily.

Besides understanding what is happening, it can be helpful to utilize some techniques to help you cope. These can include:

  • Deep breathing and positive visualization
  • Meditation and mindfulness techniques
  • Practicing skin-to-skin time with your baby in between breastfeeding sessions
  • Making sure your overall stress levels are in check
  • Spending extra time on self-care (staying hydrated, eating nutritious meals with adequate protein)
  • Placing a warm pack on your shoulders or soaking your feet in warm water
  • Listen to relaxing music while breastfeeding
  • “Talking it out” with another parent who has experienced DMER or a lactation specialist who is experienced in it

WHEN DOES DMER END?

Most parents report that their DMER symptoms get better after the early months of breastfeeding, and others report that they get better when their babies aren’t exclusively breastfeeding anymore, and their milk supply has decreased.

Many breastfeeding parents are able to breastfeed long-term, and DMER becomes a thing of the past. However, for a very small minority, weaning is the only way to eliminate all symptoms of DMER.

If your symptoms of DMER are overwhelming, making it difficult to continue nursing, or if you have any questions at all about the condition, you should reach out to your doctor, midwife, or lactation consultant. 

You may also want to consider joining an online support group for parents who experience DMER. Knowing that you are not alone is likely to make you feel much more able to manage DMER.

Citations:

Heise AM, et al. Dysphoric milk ejection reflex: A case report. International Breastfeeding Journal. 2011; 6: 6. ncbi.nlm.nih.gov/pmc/articles/PMC3126760/
Ureno TL, et al. (2019). Dysphoric milk ejection reflex: A descriptive study. Breastfeeding Medicine. Vol. 14, No. 9. liebertpub.com/doi/10.1089/bfm.2019.0091
Uvnas-Moberg K, et al. (2018). The mystery of D-MER: What can hormonal research tell us about dysphoric milk-ejection reflex? Clinical Lactation. Vol. 9, Issue 1. connect.springerpub.com/highwire_display/entity_view/node/67973/full
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Wendy

Wendy (she/her) is a writer, editor, and IBCLC. She writes frequently about breastfeeding, parenting, and health. She believes in the power of providing families with smart, evidence-based information so they can make decisions that work best for their family.Find her atwww.wendywisner.com.

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