Dysphoric milk ejection: the real reason you might feel sad when breastfeeding

Photography: Instagram @th3littlestavenger

By Charlie Middleton

As a health visitor, you get used to friends with babies asking questions about sleep, feeding and dirty nappies. Usually, these are straightforward, or you can at least direct people to the right help. But every once in a while, you get asked something unusual.

My friend (let’s call her Lisa) had a baby girl last spring. As with lots of women, Lisa planned to breastfeed her baby. While breastfeeding causes anxiety for some women, Lisa wasn’t especially worried about giving it a go.

She initially told me that the breastfeeding was going well; the baby was latching on, and there were no problems. But when we recently met for a coffee, I heard a different story.

From day one, and just before every feed at the start of the let-down reflex (the reflex that makes the milk in the breasts available to the baby), Lisa experienced a sinking feeling in the pit of her stomach. A hollow, churning sensation, similar to homesickness, but unrelated to anything she could think of. The sensation would last a few minutes, then disappear. Disappear, that is, until the next feed.

From day one, and just before every feed at the start of the let-down reflex (the reflex that makes the milk in the breasts available to the baby), Lisa experienced a sinking feeling in the pit of her stomach.

At first, she put it down to a difficult birth, sleep deprivation and perhaps the baby blues. But the feeling was so odd, so out of sync with how she generally felt, that she told no one. She was worried people would think she had postnatal depression, and she wondered if indeed she did have postnatal depression. She kept it to herself and started to dread each feed.

Weeks went by. She continued to breastfeed and express milk while the disconcerting feeling also persisted. One night, after a particularly intense experience, Lisa looked online and found that other women also experience this feeling. At last, she wasn’t alone, and the feeling had a name: dysphoric milk ejection reflex or DMER.

Poorly understood

The term DMER was first coined in 2007 by Alia Heise, a lactation consultant who experienced the condition while breastfeeding her third child. Dysphoria is a state of unease, and milk ejection refers to the hormonal reflex by which breast milk is expressed from the mammary gland.

Little is known about DMER, but Heise and other lactation experts believe it is a physical rather than a psychological condition. When women breastfeed, dopamine (a hormone associated with reward) levels decrease for prolactin (milk producing hormone) levels to rise. Heise suggests that, for some women, dopamine drops excessively, and the resulting deficit causes a range of symptoms, including anxiety, anger and self-loathing.

Some studies have shown that low dopamine levels can cause low mood and other negative emotional responses, suggesting this may be the cause.

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