Dysphoric Milk Ejection Reflex Among Japanese Mothers
by Anne Eglash MD, IBCLC, FABM
The phenomenon known as Dysphoric Milk Ejection Reflex (D-MER) manifests as a distressing emotional episode occurring just before or during milk ejection in lactating individuals. This condition has garnered attention over the past two decades. Initially, it was hypothesized that a decrease in dopamine during milk ejection might underlie these symptoms. However, a more recent theory suggests that these symptoms could be an aberrant response to elevated levels of oxytocin during milk ejection.
In a recent study conducted among 202 Japanese mothers visiting a health center for their 3-year-old child’s check-up, participants were surveyed regarding their demographics, awareness of D-MER, and any symptoms experienced during lactation. Notably, the survey did not inquire about a history of depression or anxiety.
Results indicated that around 23% of all mothers experienced D-MER with at least one child during lactation, while 34% of mothers with multiple children reported experiencing D-MER with each child.
Interestingly, 67% of the surveyed participants had never heard of D-MER.
Among those who reported experiencing D-MER, common symptoms included irritability, anxiety, sadness, restlessness, tearfulness, impatience, and homesickness.
What else? See the question!
- Mothers who reported a history of D-MER were more likely to report breastfeeding problems.
- Nearly all mothers with a history of D-MER identified the onset of symptoms within 1 month postpartum.
- 15% of mothers who reported D-MER stopped breastfeeding as a means of coping.
- Most mothers who reported D-MER never consulted anyone about their symptoms.
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Abstract
Background
The dysphoric milk ejection reflex (D-MER) is a reflex that causes temporary discomfort during milk ejection. D-MER develops due to the effects of hormones involved in lactation, and it has been reported that it is a physiological symptom different from postpartum depression, but the actual situation is unknown in Japan.
Methods
This study was conducted using a self-administered, anonymous survey of mothers of children who had undergone health checkups at three years of age at five health centers in Kagoshima city and aimed to clarify the reality and perceptions of mothers regarding D-MER. The survey period was from May to September 2022. The questionnaires were distributed to 389 mothers, and 216 (55.5% recovery rate) responses were received, of which 202 (valid response rate 93.5%) were included in the analysis.
Results
Regarding the experience of D-MER, 202 mothers in the study population had given birth to a total of 403 children and experienced D-MER when breastfeeding 62 children (15.4%). Of the 202 mothers included in the analysis, 47 (23.3%) answered that they had experienced D-MER with at least one child while breastfeeding. Sixty-six mothers (32.7%) knew about D-MER. Compared to those who had not experienced D-MER, those who had experienced D-MER had significantly higher scores on the items related to having had trouble breastfeeding (odds ratio (OR]: 3.78; 95% confidence interval (CI]: 1.57, 9.09) and knowing about D-MER (OR 2.41; 95% CI 1.20, 4.84). Regarding symptoms, irritability (n=24, 51.1%), anxiety (n=22, 46.8%), and sadness (n=18, 38.3%) ranked high. Coping strategies included distraction, focusing on the child, and, in some cases, cessation of breastfeeding. Thirty mothers (63.8%) answered that they did not consult anyone, citing reasons such as a belief that no one would be likely to understand their symptoms, and that they could not sufficiently explain their symptoms.
Conclusion
The low level of awareness of D-MER suggests that it is necessary to inform and educate mothers and the public about the physiological symptoms of D-MER. Moreover, it is necessary to listen to the feelings of mothers with D-MER and support them in coping with their symptoms.
In this study, about 25% of the mothers reported experiencing the onset of dysphoric milk ejection reflex (D-MER) immediately after childbirth, while 38% noticed symptoms emerging after one month postpartum. Some mothers recalled their D-MER symptoms starting at various intervals, including 3 months, 1 year, and 2 years postpartum. This variability prompts curiosity regarding whether the timing of D-MER onset influences the nature of the symptoms. I have observed in my clinical practice that feelings of restlessness during breastfeeding are more likely to arise after 12 months postpartum, whereas earlier onset D-MER symptoms tend to manifest as anxiety, irritability, or sadness.
Mothers in the survey shared several common coping strategies, including enduring the symptoms patiently, seeking distraction, altering or discontinuing breastfeeding, seeking empathetic support, expressing emotions openly, and finding solace by directing their feelings towards their child.
Breastfeeding and lactation medicine professionals have observed that distraction and the use of antidepressants have helped alleviate symptoms in some patients. Given that D-MER has been found to be more prevalent among individuals with a history of peripartum mood and anxiety disorders, the effectiveness of antidepressants in alleviating symptoms is not surprising.
The good news is that among multiparous mothers in this study, less than 50% experienced D-MER with each child.