Breastfeeding and the Dysphoric Milk Ejection Reflex
by Anne Eglash MD, IBCLC, FABM
Women have described many different physical symptoms during breastfeeding, particularly with milk ejection (MER), such as hives, itching, headache, and nausea. The dysphoric milk ejection reflex, aka DMER, is a distinct negative emotional event that is short-lived, and occurs right around the time of milk ejection. Women experience these negative emotions in a variety of ways, including anxiety, agitation, paranoia, fear, sadness, tearfulness, depression, worthlessness, etc. There is very little published research on this phenomenon, including the incidence in the population. The retrospective study for this week’s CQW reviewed responses to screening questions given to breastfeeding women postpartum at a large military medical center in the southeastern USA. The screening questions asked whether they experienced negative emotional responses to the milk ejection reflex and found that 9.1% of the mothers screened described having DMER sx.
The researchers then analyzed survey data from 99 recruited participants who identified as having DMER symptoms, to explore the experiences of these women. They asked questions about the types of emotional responses these women had to the MER. The majority of the survey participants were white, college educated, married, and 49.5% were not employed. At least ½ of the mothers described feeling anxiety, sadness, panic, irritability, agitation, and tearfulness during DMER. Approximately 50% of the mothers reported that lack of sleep and stress made their symptoms worse. Many reported that distraction during feeding, increased sleep, increasing water intake, exercise, solitude, music, meditation, and aromatherapy helped their DMER symptoms.
- Approximately 75% of survey respondents felt depressed between letdowns.
- Nearly 100% of the mothers felt the negative emotions come on very suddenly and for no reason.
- Approximately 50% of the mothers felt the negative emotions as soon as the infants latched.
- Only 5% of the mothers quit nursing or considered quitting due to DMER symptoms.
- Among the mothers who had a previous child, nearly 75% had DMER symptoms with lactation previously.
- Approximately 30% of the mothers had thoughts of hurting themselves during DMER.
See the Answer
Dysphoric milk ejection reflex (D-MER) is emerging as a recognized phenomenon to describe an abrupt dysphoria, or undesirable feeling that occurs with the milk ejection reflex (MER) and then goes away after a few minutes. The purpose of this study was to determine the prevalence of D-MER among breastfeeding women and to describe the experience of symptoms associated with D-MER.
Materials and Methods
To determine the prevalence of D-MER, a retrospective chart review was conducted over a 12-month period on women presenting for their 6- to 8-week postpartum visit. To describe the experience of D-MER, an anonymous cross-sectional survey consisting of 36 items was made accessible through a link to an online survey management platform. Participants were recruited through both paper and electronic posters at a variety of venues.
A prevalence rate of 9.1% was found. The respondents described similarities in their experiences with D-MER, to include feelings coming on suddenly and lasting for <5 minutes. The respondents described feeling anxious, sad, irritable, panicky, agitated, oversensitive, and tearful most often.
This is the first study to quantify a prevalence rate and describe suspected experiences of D-MER. It provides the groundwork for future research to explore other contributing factors or relationships that may be relevant to D-MER. The findings support that the experience of D-MER is different from that of postpartum depression. Future research exploring the behavior of hormones and neurotransmitters within the context of lactation could contribute to the knowledge regarding D-MER.
This is a very enlightening study. Although small, it provides information about DMER that is greatly needed. Among the mothers with DMER surveyed, the majority, ~80%, felt happy between times of DMER. Approximately 35% of mothers either quit nursing or were considering quitting due to DMER symptoms.
The authors also shared that 8% of the mothers described nausea as part of their DMER sx. Nausea and vomiting, as well as dizziness can be classic symptoms of anxiety, and even hives can occur due to anxiety. So, when women contact their physicians about what sound like non-emotional reactions to milk ejection, it would be reasonable to explore whether these symptoms have an emotional component.
Because 75% of the mothers with DMER had a history of anxiety and depression in the past, it would be wise to evaluate mothers for generalized anxiety or depression symptoms if they report DMER sx.
Although the authors state that there is no medically approved product to treat DMER, I have learned from personal communication with psychiatrists that using a medication that raises dopamine is a reasonable option, such as bupropion, although the theory that the DMER is caused by an ephemeral drop in dopamine is theoretical.