Dysphoric milk ejection reflex

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Dysphoric milk ejection reflex
Differential diagnosisPostpartum depression, dislike of breastfeeding[1]

Dysphoric milk ejection reflex (D-MER) is a condition where women who are breastfeeding develop negative emotions that begin just before the milk ejection reflex and last less than a few minutes.[1] It is different from postpartum depression and a dislike of breastfeeding.[1] Hundreds of women personally describe the condition.[1] There has, however, been little to no research into it as of 2015.[1]

Signs and symptoms[edit]

The lactating woman develops a brief period of dysphoria that begins just prior to the milk ejection reflex and continues for not more than several minutes. It may recur with every milk release, any single release, or only with the initial milk release at each feeding. D-MER always presents as an emotional reaction but may also produce a hollow or churning feeling in the pit of the stomach, nausea, restlessness, and/or general unease. When experiencing D-MER, mothers may report any of a spectrum of different unpleasant emotions, ranging from depression to anxiety to anger. Each of these emotions can be felt at a different level of intensity.[1]


  • D-MER does not appear to be a psychological response to breastfeeding. It is possible for women to have psychological responses to breastfeeding, but D-MER gives evidence of being a physiological reflex.[2]
  • D-MER is not postpartum depression or a postpartum mood disorder. A mother can have D-MER and PPD, but they are separate conditions and the common treatments for PPD do not treat D-MER. The majority of mothers with D-MER report no other mood disorders.[3]
  • D-MER is not the "breastfeeding aversion" that can happen to some mothers when continuing to nurse while pregnant. Breastfeeding aversion occurs upon nipple contact when nursing whereas D-MER is triggered by the let-down reflex, even if it is several minutes after latching.[4]


There is no product that is medically approved to treat D-MER. It has been hypothesized that efforts to raise dopamine may help, and anecdotal evidence encourages a healthy diet limiting caffeine intake and adding supplements.[5]

Many nursing mothers manage their D-MER by pumping, either exclusively or only occasionally, which may reduce symptoms and certainly helps reduce associating negative feelings with the infant. Others ultimately switch to formula feeding.

Emotional support[edit]

Awareness, understanding, and education appear to be important. Many mothers with D-MER rate their D-MER much worse prior to learning what is causing their feelings.[6] Once a mother understands that she is not alone in her condition and realizes it is a physiological condition she seems to be much less likely to wean prematurely.[4]


The first documented reference to a hormonally based negative emotional reaction while breastfeeding was found online in a forum in June 2004.[7] Prior to the launch of D-MER.org the phenomenon was unknown, unnamed, misunderstood and rarely mentioned or talked about. The term dysphoric milk ejection reflex (D-MER) came from Alia Macrina Heise who described it in 2007.[5] It was chosen due to the emotional reaction (dysphoria) to milk let-down (milk ejection reflex). The "milk ejection reflex" is abbreviated among lactation professionals and referred to as the M-E-R. In 2008 a team of lactation consultants, headed up by Diane Wiessinger, worked together and consulted with other medical professionals to do a preliminary investigation to better understand D-MER.[8] Case reports and case series have been published on the topic.[9][10]

Society and culture[edit]

D-MER has been mentioned in several breastfeeding texts and self-help books since 2010.[11]


  1. ^ a b c d e f Lawrence, Ruth A.; Lawrence, Robert M. (2015). Breastfeeding E-Book: A Guide for the Medical Professional. Elsevier Health Sciences. p. 626. ISBN 978-0-323-39420-8.
  2. ^ "Is it Psychological?". www.D-MER.org. Archived from the original on 10 July 2017. Retrieved 5 July 2019.
  3. ^ "For Moms Who Feel Bad Before Breastfeeding, This May Be Why". Postpartum Progress. 17 June 2009. Archived from the original on 15 July 2011. Retrieved 5 July 2019.
  4. ^ a b Watkinson, Marcelina; Murray, Craig; Simpson, Jane (2016). "Maternal experiences of embodied emotional sensations during breastfeeding: An Interpretative Phenomenological Analysis" (PDF). Midwifery. 36: 53–60. doi:10.1016/j.midw.2016.02.019. PMID 27106944.
  5. ^ a b "What is D-MER?". La Leche League International. 5 November 2018. Retrieved 11 May 2020.
  6. ^ "Specifics of D-MER". Archived from the original on 2013-09-03. Retrieved 2010-12-07.
  7. ^ Strange Feeling
  8. ^ "LCs Concur". Archived from the original on 2013-10-17. Retrieved 2010-12-07.
  9. ^ Cox, Suzanne. A Case of Dysphoric Milk Ejection Reflex, Breastfeeding Review 2010; 18 (1): 16-18
  10. ^ Ureño, Tamara L.; Buchheit, Toni L.; Hopkinson, Susan G.; Berry-Cabán, Cristóbal S. (January 5, 2018). "Dysphoric Milk Ejection Reflex: A Case Series". Breastfeeding Medicine. 13 (1): 85–88. doi:10.1089/bfm.2017.0086. PMID 29115857.
  11. ^ Mohrbacher, N. "Breastfeeding Answers Made Simple: A Guide for Helping Mothers" Hale Publishing. 2010.
    • Lawrence, R. A., Lawrence, R.M., "Breastfeeding A guide for the Medical Profession" Saunders. 2011. Chapter 16. p. 550–613
    • La Leche International "The Womanly Art of Breastfeeding 8th Edition" La Leche International. 2010. p. 416
    • Huggins, K. "The Nursing Mother's Companion 6th Edition" Harvard Common Press. Boston, Massachusetts. 2010. p. 171