Dysphoric Milk Ejection Reflex – Feeling Sad When Breastfeeding

Breastfeeding your baby is a beautiful and deeply bonding experience—but for some moms, it doesn’t always feel that way. Sometimes, just as your milk is about to let down, you might feel a sudden wave of sadness, dread, or anxiety. If that sounds familiar, you could be experiencing something called Dysphoric Milk Ejection Reflex, or D-MER. It’s not widely talked about, but it’s real—and you’re not alone.

What Is Dysphoric Milk Ejection Reflex (D-MER)?

D-MER is a condition where you feel a sudden drop in mood—like sadness, anxiety, hopelessness, or even anger—right before or during your milk let-down. These feelings usually last no more than a few minutes and fade as quickly as they came.

The word dysphoria simply means an unpleasant emotional state. This is what D-MER triggers: a brief, intense emotional dip tied directly to your body’s milk ejection reflex. And there are three general levels of severity: mild, moderate, and severe, depending on how intense the feelings are and how long they last.

What Causes D-MER?

It comes down to hormones—specifically dopamine and prolactin. Dopamine helps regulate your emotions and also plays a role in milk production. When it dips suddenly (so that prolactin can rise and do its job), some moms experience an emotional crash. It’s a chemical chain reaction, not a psychological issue or emotional weakness.

In most people, dopamine stabilizes again as prolactin increases. But if dopamine drops too sharply or behaves differently, D-MER symptoms can occur. Importantly, this response is reflexive—not emotional or mental—and moms can’t control it.

What Does Dysphoric Milk Ejection Reflex Feel Like?

D-MER symptoms can vary, but here’s what many moms report:

• A sinking feeling in the stomach
• Sudden sadness or hopelessness
• Anxiety, panic, or dread
• Irritability or even anger
• Feeling emotionally “off” or disconnected

These feelings:

• Come on suddenly, just before or during milk let-down
• Typically last 30 seconds to 2 minutes
• May happen with every let-down, or just the first of a session
• Can also occur with pumping or spontaneous let-downs (but not always)
• Do not happen when simply thinking about nursing
• Are not caused by nipple contact or tugging

What D-MER Is Not

Dysphoric Milk Ejection Reflex is often misunderstood. Here’s what it’s not:

• It’s not postpartum depression or a general mood disorder
• It’s not a dislike of breastfeeding
• It’s not a psychological reaction to nursing
• It’s not breastfeeding aversion (though they can overlap)
• It’s not about nausea or physical discomfort

If you feel low or anxious most of the time—not just at let-down—you may be dealing with postpartum depression. It’s okay to ask for help, and it’s important to know the difference.

How Common Is D-MER?

Studies suggest around 6 to 9% of breastfeeding people experience D-MER. That number may be higher since many women don’t know what D-MER is or think something else is wrong. The lack of awareness means it’s often underreported or misdiagnosed.

Can D-MER Affect Breastfeeding?

Yes. For some moms, D-MER is mild and manageable. For others, it can be so distressing that they choose to wean early. One study found that nearly half of breastfeeding parents with D-MER stopped nursing because of it.

But identifying D-MER—and understanding it’s hormonal, not emotional—can make a huge difference. You can manage it, and in some cases, treat it.

What Can Help With D-MER?

There’s no one-size-fits-all solution, but here are some things that may help:

• Name it: Just knowing D-MER exists can be a huge relief. It’s not in your head.
• Distract yourself: Scroll your phone, watch a show, listen to music—something to shift your attention during let-down.
• Stay nourished: Low blood sugar and dehydration can make things worse. Eat and drink regularly.
• Track your symptoms: Journaling or using an app can help you see patterns and confirm the feelings do pass.
• Talk to someone: A lactation consultant, postpartum therapist, or D-MER-aware doctor can help.

If D-MER is severe, and dopamine regulation is confirmed to be the issue, some medical treatments may help—but only under professional supervision.

When to Get Help

If your feelings are intense, last longer than a few minutes, or start affecting your well-being or bonding with your baby, it’s time to talk to someone. A healthcare provider—especially one trained in perinatal mental health—can help you sort through what’s going on.

And if they haven’t heard of D-MER? Don’t hesitate to bring it up. Share what you’ve learned here.

Final Thoughts: You’re Not Alone

D-MER is a challenging experience, but it’s also manageable—and more common than most people realize. The fact that you’re searching for answers means you’re already doing something brave.

This is not your fault. It doesn’t say anything about how much you love your baby. D-MER is a reflex, not a reflection of who you are as a parent.

You’re doing great. Keep going. And reach out if you need support—you deserve it.

References

• Dysphoric Milk Ejection Reflex: Characteristics, Risk Factors, and Its Association with Depression Scores and Breastfeeding Self‑Efficacy — Breastfeeding Medicine (2023‑09)
• Dysphoric Milk Ejection Reflex: The Psychoneurobiology of the Breastfeeding Experience — Frontiers in Global Women’s Health (2021)
• Dysphoric Milk Ejection Reflex: Measurement, Prevalence, Clinical Features — Breastfeeding Medicine (2024)
• Understanding Dysphoric Milk Ejection Reflex: When Breastfeeding Feels Anything But Positive — Postpartum Support International (2024)