When Breastfeeding Hurts the Heart: Understanding D-MER (Dysphoric Milk Ejection Reflex)

Ashley Strengholt
5 days ago
5 min read

Imagine sitting down to nurse your baby - and just as your milk lets down, you’re hit with a wave of sadness, anxiety, or even dread. It lasts only seconds or a minute, then it’s gone. You love your baby and want to breastfeed, but can’t shake that feeling. You might wonder: Am I broken? Is this postpartum depression?

This may actually be something called Dysphoric Milk Ejection Reflex (D-MER) - a little-known but very real condition affecting breastfeeding mothers worldwide.

What Exactly Is D-MER?

D-MER is a reflexive, brief onset of intense negative emotions - dysphoria - that occurs just before or during the milk ejection (let-down) reflex. Mothers describe it as a “dark wave” or “drop in the gut” that happens seconds before milk release (Heise & Wiessinger, 2011).

Symptoms may include:

A hollow or sinking feeling in the stomach
Irritability, agitation, or anxiety
Sadness, hopelessness, or even guilt
A strong urge to stop breastfeeding or pull away

These emotions are temporary, lasting 30 seconds to 2 minutes, and they pass once milk begins to flow (Ureño et al., 2019). D-MER does not mean a mother dislikes breastfeeding or her baby; it’s a physiological reflex, not an emotional rejection.

What Causes D-MER? Is It Real?

Yes - D-MER is real. Multiple clinical studies and case reports have confirmed its existence as a distinct physiological response separate from postpartum depression or anxiety (Heise & Wiessinger, 2011; Ureño et al., 2019; Deif et al., 2021).

The Dopamine Theory

The leading theory is that D-MER results from a rapid drop in dopamine, a neurotransmitter linked to motivation, mood, and pleasure (Deif et al., 2021). During milk ejection, dopamine must fall to allow prolactin and oxytocin to rise - hormones responsible for milk production and let-down. For some women, this dopamine drop may occur too sharply or deeply, triggering a temporary emotional crash.

The Oxytocin/Nervous System Theory

A second theory suggests that oxytocin surges may activate the autonomic nervous system, triggering physical sensations like nausea, panic, or discomfort (Zutić, 2025). In mothers already sensitive to hormonal changes or stress, this can feel like emotional distress.

Because symptoms occur only during milk let-down, D-MER is recognized as a reflexive, not a psychological, condition (Cleveland Clinic, 2023).

How Common Is D-MER?

Prevalence estimates vary because the condition is still underrecognized. Research suggests between 5% and 9% of breastfeeding women experience D-MER symptoms (Cleveland Clinic, 2023; Ureño et al., 2019).

A recent study validating the “D-MER Questionnaire” found 5.9% of participants screened positive (Zutić, 2025), while earlier small-scale studies estimated up to 9–14% (Deif et al., 2021).

However, increased recognition doesn’t make D-MER “normal” - it simply reflects better awareness of a legitimate neuroendocrine issue affecting a significant minority of mothers.

How Long Does It Last?

For many mothers, D-MER symptoms improve as lactation becomes established - often within a few weeks to months. Others experience it throughout their entire breastfeeding journey (Cleveland Clinic, 2023).

The intensity may vary:

Mild: fleeting sadness or restlessness during let-down.
Moderate: strong emotional discomfort that disrupts bonding or enjoyment of feeding.
Severe: intense negative emotions or fleeting thoughts of self-harm (Ureño et al., 2019).

It’s crucial to note: D-MER always coincides with milk release, unlike postpartum mood disorders, which are constant. Recognizing this distinction helps mothers seek appropriate care.

What Can a Mama Do to Manage or Prevent D-MER?

While no single cure exists, several approaches can help regulate dopamine levels, calm the nervous system, and make breastfeeding more manageable.

1. Education & Awareness

Simply knowing D-MER exists can relieve guilt and fear. Many women feel immediate comfort once they understand it’s a physical reflex, not a reflection of their love or faith (Heise & Wiessinger, 2011).

2. Rest, Nutrition, and Hydration

Fatigue, low blood sugar, and dehydration can worsen hormonal imbalance. Mothers should eat small, protein-rich meals, stay hydrated, and rest whenever possible (Cleveland Clinic, 2023).

3. Magnesium and B-Vitamins

These nutrients support dopamine and serotonin regulation. Magnesium glycinate or B-complex supplements may help reduce irritability or anxiety linked to D-MER (Deif et al., 2021).

4. Mindfulness and Grounding Techniques

Since D-MER is a reflexive response, grounding the body during let-down can help calm the brain’s alarm system:

Deep breathing (inhale for 4, exhale for 6)
Focus on the baby’s warmth or heartbeat
Repeat a calming prayer or affirmation, such as “This will pass.”

5. Avoid Known Triggers

Some women report worsened symptoms with caffeine, dehydration, stress, or oversupply from excessive pumping. Tracking patterns can reveal avoidable triggers (Ureño et al., 2019).

6. Emotional and Faith-Based Support

For many mothers, prayer, scripture meditation, and faith-centered community support offer peace during challenging feeds.

Combining spiritual grounding with professional lactation guidance creates both emotional and physiological stability.

What to Avoid

Ignoring symptoms — D-MER deserves attention and support.
Overpumping or oversupply — increases let-down frequency, which can trigger more dysphoric episodes.
Assuming it’s “just in your head” — this is a hormonal reflex, not weakness.
Comparing yourself to others — every lactation journey is different.

Should a Mom Stop Breastfeeding if She Has D-MER?

Not necessarily. Most mothers with D-MER can continue breastfeeding with proper understanding and care (Cleveland Clinic, 2023).

However, if symptoms become severe - especially with persistent depression or intrusive thoughts - it’s vital to seek professional help. Partnering with:

IBCLC (International Board Certified Lactation Consultant)
Faith-based or biblical counselor (for spiritual and emotional care)
Perinatal mental health therapist (for psychological support)

This integrated care ensures both mother and baby’s well-being. Stopping breastfeeding is a personal choice and not a failure - but many mothers find that education, rest, and support help them overcome D-MER without weaning.

Hope for the Journey

D-MER can feel discouraging - a paradox of deep love mixed with fleeting emotional darkness. But it’s not a moral failure or mental illness; it’s a physical response that can be managed with care, support, and faith.

With time and balance, many mothers find the storm passes - and breastfeeding once again becomes peaceful, sacred, and joy-filled.

You are not broken, Mama. You are beautifully designed - body, mind, and spirit - even when your hormones need a little extra grace.

References

Cleveland Clinic. (2023, April 6). Dysphoric milk ejection reflex (D-MER). Retrieved from https://my.clevelandclinic.org/health/diseases/24879-dysphoric-milk-ejection-reflex
Deif, R., Burch, E. M., Azar, J., Yonis, N., & Abou Gabal, M. (2021). Dysphoric milk ejection reflex: The psychoneurobiology of the breastfeeding experience. Frontiers in Global Women’s Health, 2, 669826. https://doi.org/10.3389/fgwh.2021.669826
Heise, A. M., & Wiessinger, D. (2011). Dysphoric milk ejection reflex: A case report. International Breastfeeding Journal, 6(6), 1–4. https://doi.org/10.1186/1746-4358-6-6
Ureño, T. L., Buchheit, T. L., Hopkinson, S. G., Berry-Cabán, C. S., & Adams, A. (2019). Dysphoric milk ejection reflex: A descriptive study. Breastfeeding Medicine, 14(11), 666–673. https://doi.org/10.1089/bfm.2019.0111
Zutić, M. (2025). Dysphoric milk ejection reflex: Measurement, prevalence and clinical features. Breastfeeding Medicine. Advance online publication. https://pubmed.ncbi.nlm.nih.gov/39501787/