For those who experience Dysphoric Milk Ejection Reflex (DMER), breastfeeding can trigger a wave of unexpected and distressing emotions. In this blog we explain what DMER is, explore the symptoms and potential causes, and provide insights into treatment options that can help mothers manage this challenging aspect of breastfeeding.
What is Dysphoric Milk Ejection Reflex (DMER)?
Dysphoric Milk Ejection Reflex, commonly referred to as DMER, is a condition that affects some breastfeeding mothers. It causes a brief but intense period of negative emotions just before milk is released (known as milk letdown). It's important to understand that DMER is different then postpartum depression or a general aversion to breastfeeding. Rather, it is a physiological response, believed to be triggered by hormonal changes during the milk ejection process.
The experience of DMER can be profoundly unsettling for mothers. The sudden onset of negative feelings can be alarming, particularly when breastfeeding is expected to be a positive experience. However, it’s important to recognise that DMER is not a reflection of a mother's emotional state outside of breastfeeding nor her feelings towards her child. Instead, it is a biological response that occurs due to specific hormonal shifts in the body.
The symptoms of DMER are usually brief, lasting between 30 seconds and 2 minutes, but they can be intense. Understanding this condition can be a first step towards managing its impact and continuing the breastfeeding journey with confidence.
Symptoms of DMER
The symptoms of Dysphoric Milk Ejection Reflex can vary widely from one mother to another, but they generally share a common theme of negative emotional experiences. These symptoms typically occur just before or during the milk letdown process. For some women, these symptoms are mild and fleeting, while for others, they can be more severe and distressing.
Some of the most commonly reported symptoms of DMER include:
Sudden feelings of sadness or depression: Many mothers describe a quick, overwhelming sense of sadness or melancholy that seems to come out of nowhere.
Anxiety or panic: Feelings of unease or panic can set in suddenly, even if there is no apparent cause for concern.
Irritability or anger: Some mothers report feeling unusually irritable or even angry during milk letdown, which can be disconcerting.
Restlessness: A sense of being on edge or feeling unsettled is another common symptom.
A hollow feeling in the pit of the stomach: This physical sensation is often accompanied by emotional discomfort.
Emotional unease or dread: There may be a pervasive feeling of dread or emotional discomfort, making the experience of breastfeeding less enjoyable.
These emotional responses are typically short-lived but can be intense. For some mothers, they may occur during every breastfeeding session, while for others, the symptoms may be less frequent. Regardless of the frequency or intensity, these experiences can be challenging to cope with, particularly when they are not well understood or when mothers feel isolated in their experience.
Understanding that these symptoms are part of a physiological response, rather than a psychological problem, can be an important step in managing DMER. It can also help in distinguishing DMER from other postpartum mood disorders, such as postpartum depression, which require different approaches to treatment.
As awareness of DMER grows, more mothers and healthcare providers are recognising the importance of addressing these symptoms openly. This can lead to better support and more effective coping strategies, allowing mothers to continue breastfeeding while managing the challenges posed by DMER.
Causes of Dysphoric Milk Ejection Reflex (DMER)
Understanding the causes of Dysphoric Milk Ejection Reflex (DMER) is crucial for developing effective coping strategies and treatment options. While research on DMER is still in its early stages, current understanding suggests that the condition is closely linked to hormonal fluctuations that occur during the milk ejection process. These hormonal shifts are a natural part of breastfeeding, but in women with DMER, they seem to trigger an atypical response that leads to the distressing symptoms associated with the condition.
The Role of hormonal changes
The primary hormonal players involved in breastfeeding are oxytocin and dopamine. Oxytocin, often referred to as the "love hormone," is responsible for triggering milk letdown. It is released in response to the baby’s suckling, prompting the milk to flow from the mammary glands to the nipple. Normally, the release of oxytocin is a positive experience, associated with feelings of warmth, relaxation, and bonding with the baby.
Dopamine, on the other hand, is a neurotransmitter that plays a key role in regulating mood, pleasure, and reward. During the milk ejection reflex, there is typically a controlled decrease in dopamine levels, which allows oxytocin to act effectively. This process is usually smooth and unnoticed by the mother.
However, in the case of DMER, it is believed that there is an inappropriate and abrupt drop in dopamine levels when oxytocin is released. This sudden decrease in dopamine is thought to trigger the negative emotional responses that characterise DMER. Instead of experiencing the usual positive feelings associated with breastfeeding, mothers with DMER are hit with a wave of negative emotions just as their milk lets down.
This theory is supported by the observation that the symptoms of DMER are closely tied to the timing of milk letdown, occurring just before or during this process. The fleeting nature of the symptoms—lasting only a minute or two—also aligns with the idea that they are directly linked to the rapid hormonal changes taking place during milk ejection.
It’s important to note that DMER is not caused by psychological factors such as stress or anxiety about breastfeeding. Instead, it is a physiological response, meaning it is rooted in the body’s natural processes rather than in the mind. This distinction is crucial for mothers who may feel confused or guilty about their emotional reactions during breastfeeding. Recognising DMER as a biological response can help reduce the stigma and allow mothers to seek the support they need without feeling ashamed.
Other contributing factors
While the hormonal explanation is the most widely accepted theory for the cause of DMER, there may be other contributing factors that can influence the severity or frequency of the condition. These can include:
Genetic Predisposition: Some experts believe that genetic factors may play a role in whether or not a mother experiences DMER. While more research is needed in this area, it’s possible that some women are more prone to the rapid dopamine fluctuations that lead to DMER due to their genetic makeup.
Previous Mental Health History: Although DMER is not a psychological condition, women who have a history of mental health issues, such as depression or anxiety, may be more sensitive to the emotional impact of DMER. However, it’s important to emphasise that having DMER does not mean a mother has a mental health disorder.
Sensitivity to Hormonal Changes: Some women may be more sensitive to hormonal changes in general, making them more likely to experience DMER. This sensitivity could be related to other conditions influenced by hormonal fluctuations, such as premenstrual dysphoric disorder (PMDD).
Sleep Deprivation and Fatigue: The postpartum period is often marked by significant sleep deprivation and physical exhaustion. These factors can exacerbate the emotional impact of DMER, making the symptoms feel more intense or harder to manage.
Understanding these potential contributing factors can help mothers and healthcare providers identify DMER and distinguish it from other conditions that may cause similar symptoms. It also underscores the importance of addressing DMER from a holistic perspective, taking into account the mother’s overall health and wellbeing.
When to Seek Help
While DMER is a physiological condition, it’s important to recognise when the symptoms are interfering with a mother’s ability to care for herself or her baby. If the emotional distress caused by DMER is overwhelming or persistent, it may be necessary to seek additional support. Mothers should feel empowered to reach out to their healthcare providers, mental health professionals, or support networks if they are struggling with the impact of DMER. There is no shame in seeking help, and doing so can make a significant difference in managing the condition and maintaining a positive breastfeeding experience.
Support Groups
Connecting with other mothers who experience DMER can provide invaluable emotional support and practical coping strategies. Support groups, whether online or in-person, offer a safe space to share experiences, exchange advice, and find comfort in knowing that others are going through similar challenges.
Organisations such as Postpartum Support International offer resources and support for mothers dealing with DMER and other postpartum conditions. These communities can provide both emotional reassurance and practical tips for managing the symptoms of DMER.
Consultation with Healthcare Providers
In some cases, mothers may find that their DMER symptoms are particularly severe or difficult to manage with self-care strategies alone. In such instances, it’s important to seek guidance from a healthcare provider who is knowledgeable about DMER.
While there is no standard medical treatment for DMER, some healthcare providers may consider options that can help regulate dopamine levels. This could include the use of medications that influence dopamine pathways, though such treatments require careful consideration and monitoring.
It’s also important for healthcare providers to differentiate DMER from other conditions, such as postpartum depression or anxiety disorders, which may require different forms of treatment. Open communication with a trusted healthcare provider can help mothers explore their options and find the most appropriate support for their situation.
Dysphoric Milk Ejection Reflex (DMER) is a challenging yet manageable condition that affects some breastfeeding mothers. By understanding the symptoms, exploring the causes, and implementing effective coping strategies, many women can continue breastfeeding successfully despite the challenges of DMER.
It’s important to remember that experiencing DMER does not reflect on a mother’s abilities or her bond with her baby. With the right support, education, and management, mothers can navigate this condition and enjoy a fulfilling breastfeeding journey. Whether through mindfulness practices, lifestyle adjustments, or connecting with support groups, there are many ways to manage DMER and continue providing the nourishment and care that breastfeeding offers.
For more information and support on managing DMER, consider exploring resources from La Leche League International, the Australian Breastfeeding Association, and the International Breastfeeding Journal. By staying informed and seeking support, mothers can find the strength to overcome the challenges of DMER and continue their breastfeeding journey with confidence.
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