Breastfeeding can be one of the most amazing and rewarding experiences of being a mom. It activates the feel-good hormone Oxytocin and helps mom and baby create a deep connection… Right? Well, not necessarily. In fact, some women experience the exact opposite and actually feel sad, or angry, when breastfeeding. How is that possible? Well, hormones definitely have a hand in it…

What is D-MER?

Dysphoric milk ejection reflex, or D-MER, is a little-known phenomenon characterized by sudden negative feelings in breastfeeding women. The feelings only last a few minutes, begin around the time of the let-down, also known as milk release, and dissipate as abruptly as they appear. Women who experience D-MER report feelings of:

• Intense sadness
• Anxiety or paranoia
• Irritability
• Self-loathing
• Panic
• Nausea
• Restlessness or unease
• Anger
• Dread

Some women also report thoughts of self-harm.

A study from 2019 found that D-MER may affect up to 9% of breastfeeding women. There seems to be some consistency in the length of the episodes, with most women reporting that episodes last no longer than five minutes. Here’s where it gets complicated. Among women who do experience DMER, they don’t experience it with every let-down. And how long the feelings come back for also seems to differ — some women experience symptoms for a few days, while others report having them for months.

Why does it happen?

The truth is we don’t know exactly why it happens. However, there are a couple of prevailing theories.

The first relies on the connection between Prolactin and Dopamine. It claims that the two are inversely related. This means that when Prolactin is elevated, Dopamine is reduced, and vice versa. So, according to this theory, there must be a sudden drop in Dopamine just before the let-down, as Prolactin levels rise to allow for the milk to release.

How does Dopamine affect breastfeeding? Well, in addition to being a hormone, Dopamine is also a neurotransmitter. It allows you to feel positive things, like pleasure and motivation. Which is why a sudden drop in Dopamine could quickly affect someone’s overall mood.

The second theory is that D-MER could be related to increased Oxytocin levels. Wait. What?  Oxytocin is generally associated with feelings of calm, contentment, and bonding, no? So how can high levels of Oxytocin cause you to feel sad when breastfeeding?

Well, the idea is that Oxytocin causes mothers to feel deeply connected to their babies, which then causes them to feel very protective of them. It’s theorized that this may stimulate the fight-or-flight reflex, causing paranoia, irritability, anger, and other symptoms of D-MER.

Though awareness of D-MER is increasing, clearly, finding the root causes requires a lot more research.

How is DMER treated?

Though the exact cause isn’t known, it doesn’t mean you have to suffer.

Currently, there are no recommended medications for D-MER. But, sometimes, knowing that what you’re experiencing is recognized by the medical community — albeit a small portion of the community — can help you feel less alone.

And sometimes, you need actionable tips.

DMER coping strategies

First things first: Tell your primary care physician and your lactation consultant if you have one. Explain your symptoms, how it’s making you feel, and ask if they’ve ever heard of D-MER. Then tell them what you know about it. A good healthcare professional should be open to hearing your concerns and willing to do more research on your behalf.

And if you can, please tell your partner or a trusted friend or family member. They can support you before, during, or after episodes and advocate for you. Plus, it’s always worth having someone around who knows what you’re going through.

It’s also really important to know your symptoms and triggers. So, if you notice that other people become extremely irritating to you while breastfeeding, try finding a quiet, private place to nurse. If you feel sad when breastfeeding, consider watching your favorite movie or show or calling a friend. You can also try eating a piece of dark chocolate to help boost your Endorphin levels.

Now, we’re not saying that eating chocolate in a room by yourself will solve all your problems. It can, though, help in the moment. And with multiple coping strategies and solid support from those around you, including medical types, DMER can be successfully managed.

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