Dysphoric Milk Ejection Reflex (D-MER): Symptoms, Causes, Treatment

What are the symptoms of dysphoric milk ejection reflex?

Dysphoric milk ejection reflex (D-MER) is a condition that some breastfeeding women experience, characterized by negative emotions that occur just before milk release (letdown) and continue for a few minutes. Symptoms of D-MER may include:

1. Feelings of Sadness or Anxiety: Women with D-MER often report sudden and intense feelings of sadness, anxiety, or irritability that coincide with milk letdown.
2. Emotional Lability: Mood swings or emotional changes that occur specifically with the milk ejection reflex.
3. Depressive Symptoms: Some women may experience symptoms of depression, such as feelings of hopelessness, worthlessness, or guilt.
4. Physical Symptoms: Symptoms such as nausea, stomach tightening, or a “pit in the stomach” feeling can occur with D-MER.
5. Other Emotional Responses: Some women may describe a general feeling of unease or discomfort, often focused on the breast or chest area.

These symptoms are transient and typically last for only a few minutes, resolving once the milk ejection reflex has completed. It’s important to note that D-MER is not related to breastfeeding itself or to mother-infant bonding, and it is not a psychological issue. It is believed to be caused by a sudden drop in dopamine levels that occurs with milk release, leading to the negative emotional response.

What are the causes of dysphoric milk ejection reflex?

The exact cause of dysphoric milk ejection reflex (D-MER) is not fully understood, but it is believed to be related to the sudden drop in dopamine levels that occurs with milk release (letdown) during breastfeeding. Dopamine is a neurotransmitter involved in regulating mood, and a rapid decrease in dopamine levels can lead to the negative emotional symptoms experienced by women with D-MER.

It’s important to note that D-MER is a physiological response and not a psychological issue. It is not related to breastfeeding technique, milk supply, or mother-infant bonding. Women with D-MER are able to breastfeed normally once the initial negative feelings associated with milk letdown subside.

Research into the underlying causes of D-MER is ongoing, and further studies are needed to fully understand this phenomenon. If you are experiencing symptoms of D-MER, it’s important to discuss them with a healthcare provider or lactation consultant for support and management strategies.

How is the diagnosis of D-MER made?

The diagnosis of dysphoric milk ejection reflex (D-MER) is typically based on the description of symptoms provided by the breastfeeding mother. Healthcare providers, such as lactation consultants or physicians, may ask a series of questions to determine if the mother’s symptoms align with those commonly associated with D-MER. These questions may include:

1. Timing of Symptoms: Symptoms of D-MER occur specifically with the milk ejection reflex and typically last for only a few minutes, resolving once the letdown is complete.
2. Nature of Symptoms: Women with D-MER describe sudden and intense feelings of sadness, anxiety, or irritability that coincide with milk letdown.
3. Frequency and Duration: The frequency and duration of symptoms can vary among individuals, but they are typically consistent with each milk ejection.
4. Effect on Breastfeeding: D-MER does not typically affect the mother’s ability to breastfeed, and women with D-MER are able to breastfeed normally once the initial negative feelings associated with milk letdown subside.
5. Exclusion of Other Conditions: It’s important to rule out other potential causes of negative emotions or discomfort during breastfeeding, such as postpartum depression or breastfeeding difficulties unrelated to D-MER.

The diagnosis of D-MER is primarily based on the presence of these characteristic symptoms and the exclusion of other potential causes. There are currently no specific diagnostic tests for D-MER, so the diagnosis is made based on the clinical presentation and history provided by the mother.

What is the treatment for dysphoric milk ejection reflex?

Treatment for dysphoric milk ejection reflex (D-MER) aims to alleviate the negative emotional symptoms experienced by breastfeeding women during milk letdown. While there is no specific cure for D-MER, there are several strategies that may help manage the symptoms:

1. Awareness and Education: Understanding that D-MER is a physiological response and not a psychological issue can help reduce anxiety and distress associated with the condition.
2. Emotional Support: Seeking support from healthcare providers, lactation consultants, and other breastfeeding mothers can provide reassurance and coping strategies.
3. Relaxation Techniques: Practicing relaxation techniques such as deep breathing, meditation, or progressive muscle relaxation can help reduce anxiety and stress during breastfeeding.
4. Timing of Feeds: Some women find that feeding more frequently or expressing milk before feeds can reduce the intensity of D-MER symptoms.
5. Healthy Lifestyle: Maintaining a healthy lifestyle with regular exercise, balanced nutrition, and adequate rest can help improve overall well-being and may reduce the severity of D-MER symptoms.
6. Medication: In some cases, healthcare providers may prescribe medication to help manage the symptoms of D-MER. These may include antidepressants or medications that affect dopamine levels, but their use should be carefully considered and monitored.

It’s important for women experiencing D-MER to work closely with their healthcare providers to develop a management plan that addresses their individual needs and preferences. With proper support and management strategies, many women are able to continue breastfeeding successfully despite experiencing D-MER.

Can stress while breastfeeding affect the baby?

Stress experienced by a breastfeeding mother can potentially affect both the mother and the baby, although the impact can vary depending on various factors including the severity and duration of the stress, how the mother copes with stress, and the overall support system available to the mother. Here are some ways in which stress may affect breastfeeding:

1. Milk Supply: Stress can affect milk production, leading to a decrease in milk supply. This can be due to hormonal changes that occur in response to stress.
2. Letdown Reflex: Stress can interfere with the letdown reflex, which is the release of milk from the breast. This can make breastfeeding more difficult and less effective.
3. Breastfeeding Behavior: Babies may pick up on their mother’s stress, which can affect their breastfeeding behavior. They may become more fussy or have difficulty latching.
4. Emotional Well-being: Stress can impact a mother’s emotional well-being, leading to feelings of frustration, guilt, or sadness, which can affect her ability to bond with her baby.
5. Immune System: Prolonged stress can weaken the immune system, making both the mother and the baby more susceptible to illness.

While some level of stress is normal, it’s important for breastfeeding mothers to take steps to manage stress and prioritize their well-being. This may include seeking support from healthcare providers, lactation consultants, and other breastfeeding mothers, as well as practicing self-care techniques such as relaxation exercises, mindfulness, and adequate rest.