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Dysphoric Milk Release Reflex as A Problem in Breastfeeding Women

Year 2025, Volume: 8 Issue: 1, 76 - 80, 26.03.2025
https://doi.org/10.62425/esbder.1518151

Abstract

Although breastfeeding is extremely beneficial to the health of women and infants, breastfeeding rates are not at the desired levels. The literature includes medical and physical difficulties that can lead to early discontinuation of breastfeeding. However, studies examining the impact of women's emotional experiences on the breastfeeding process are rather limited. Dysphoric milk release reflex (DMER) is characterised by dysphoria that occurs during milk release and lasts for several minutes. Symptoms include sudden and unpleasant feelings of anxiety, sadness, irritability or panic. The exact cause of DMER is not known. Studies suggest that the sudden drop in dopamine at the start of lactation causes a short-term dopamine deficiency in women, which can lead to dysphoria. It is known that women experiencing DMER have a negative process towards breastfeeding due to the uncomfortable feelings, and some women may stop breastfeeding or feel compelled to continue breastfeeding because of this discomfort. Although there is no medically proven treatment, it has been suggested that various non-pharmacological methods such as distraction, lifestyle changes, music and aromatherapy may be effective. As DMER has only recently been recognised, the literature is limited. The aim of this review is to present the current literature on DMER.

References

  • Ahmed, M., Mahmud, A., Mughal, S., & Shah, H.H. (2024). Dysphoric milk ejection reflex - call for future trials. Archives of Gynecology and Obstetrics, 310(1),627-630. doi: 10.1007/s00404-024-07503-4.
  • Beggs, B., Koshy, L., & Neiterman, E. (2021). Women’s Perceptions and Experiences of Breastfeeding: a scoping review of the literature. BMC Public Health, 21,2169. https://doi.org/10.1186/s12889-021-12216-3
  • Claesson, I.M., Larsson, L., Steen, L., & Alehagen, S. (2018). You just need to leave the room when you breastfeed Breastfeeding experiences among obese women in Sweden - A qualitative study. BMC Pregnancy Childbirth, 18(1),1–10. https://doi.org/10.1186/s12884-017-1656-2
  • Cox, S. (2010). A case of dysphoric milk ejection reflex (D-MER). Breastfeed Rev, 18(1),16-8. PMID: 20443435.
  • Deif, R., Burch, E.M., Azar, J., Yonis, N., Abou Gabal, M., El Kramani, N., & DakhlAllah, D. (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
  • Dukuzumuremyi, J.P.C., Acheampong, K., Abesig, J., Luo, J. (2020). Knowledge, attitude, and practice of exclusive breastfeeding among mothers in East Africa: A systematic review. Int Breastfeed Journal, 15(1), 70.
  • Francis, J, Mildon, A., Stewart, S., Underhill, B., Tarasuk, V., & Di Ruggiero, E. (2020). Vulnerable mothers’ experiences breastfeeding with an enhanced community lactation support program. Maternal Child Nutrition, 16(3),16. https://doi.org/10.1111/mcn.12957
  • Frawley, T., & McGuinness, D. (2023). Dysphoric milk ejection reflex (D-MER) and its implications for mental health nursing. International Journal of Mental Health Nursing, 32(2),620-626. doi: 10.1111/inm.13115.
  • Hacettepe University Institute of Population Studies. (2019, November). 2018 Turkey Demographic and Health Survey. Hacettepe University Institute of Population Studies, Presidency of the Republic of Turkey Presidency of Strategy and Budget Presidency and TUBITAK, Ankara, Turkey.
  • Heise, A.M., & Wiessinger, D. (2011). Dysphoric milk ejection reflex: A case report. International Breastfeeding Journal, 6(1),1-7. https://doi.org/10.1186/1746-4358-6-6
  • Isık, H., & Arca, G. (2019). The Role of Midwife and Nurse Regarding Breast Milk and Breastfeeding. Health Sciences University Journal of Nursing, 1(3), 221-228. https://dergipark.org.tr/tr/pub/sbuhemsirelik/issue/50916/605826
  • Kacır, A., Karabayir, N., Karademir, F., Basıbuyuk, M., Ocal, O., Buke, Ö., & Bilgin, D.D. (2024). Impact of Dysphoric Milk Ejection Reflex on Mental Health. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 19(7),547–553. https://doi.org/10.1089/bfm.2024.0055
  • Liu, H., Li, J., Li, X., & Lu, H. (2023). Dysphoric Milk Ejection Reflex: Report of Two Cases and Postulated Mechanisms and Treatment. Breastfeeding Medicine, 18(5),388-394. doi: 10.1089/bfm.2022.0206.
  • Moriyama, Y., Nakao, Y., &Yamamoto, N. (2024). Dysphoric milk ejection reflex among Japanese mothers: a self-administered survey. International Breastfeed Journal, 19, 21. https://doi.org/10.1186/s13006-024-00625-0
  • Skowrońska, K., Chmura, A., Baciur, P., & Środoń, A. (2022). Dysphoric milk ejection reflex as a new diagnostic and therapeutic challenge in lactation care - literature review. Journal of Education, Health and Sport, 12(11),48–53. https://doi.org/10.12775/JEHS.2022.12.11.006
  • Stacey AJ. (2020). Dysphoric milk ejection reflex. Breastfeeding Review, 28(1), 29-32. https://pubmed.ncbi.nlm.nih.gov/20443435/
  • UNICEF. (2019, October 14). Monitoring the situation of children and women. United Natıons International Children's Emergency Found. https://data.unicef.org/resources/dataset/sowc2019-statistical-tables
  • Ureño, T. L., Berry-Cabán, C. S., Adams, A., Buchheit, T. L., & Hopkinson, S. G. (2019). Dysphoric Milk Ejection Reflex: A Descriptive Study. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 14(9),666–673. https://doi.org/10.1089/bfm.2019.0091
  • Ureño, T.L., Buchheit, T.L., Hopkinson, S.G., & Berry-Cabán, C.S. (2018). Dysphoric Milk Ejection Reflex: A Case Series. Breastfeed Medicine, 13(1),85-88. doi: 10.1089/bfm.2017.0086.
  • Uvnas-Moberg, K., & Kendall-Tacket, K. (2018). The mystery of D-MER: What can hormonal research tell us about dysphoric milk-ejection reflex? Clinical Lactation, 9(1), 23-29. https://doi.org/ 10.1891/2158-0782.9.1.23
  • WHO, GBC, UNICEF. (2023, December). Global breastfeedıng scorecard 2023 rates of breastfeedıng ıncrease around the world through ımproved protectıon and support. https://www.unicef.org/documents/global-breastfeeding-scorecard-2023#:~:text=For%202023%20the%20scorecard%20demonstrates,target%20of%2050%25%20by%202025.
  • World Health Organization. (2020, August 12). Infants exclusively breastfed for the first six months of life. https://www.who.int/data/gho/data/indicators/indic ator-details/GHO/infants exclusively-breastfed-forthe-first-six-months-of-life
  • Zychlinsky S., AnnaCappenberg, R., IoannisGarcia G., JesusHapple C. (2025) Risk factors for dysphoric milk ejection reflex. American Journal of Obstetrics & Gynecology, 232(2), 37-39.

Dysphoric Milk Release Reflex as A Problem in Breastfeeding Women

Year 2025, Volume: 8 Issue: 1, 76 - 80, 26.03.2025
https://doi.org/10.62425/esbder.1518151

Abstract

Although breastfeeding is extremely beneficial to the health of women and infants, breastfeeding rates are not at the desired levels. The literature includes medical and physical difficulties that can lead to early discontinuation of breastfeeding. However, studies examining the impact of women's emotional experiences on the breastfeeding process are rather limited. Dysphoric milk release reflex (DMER) is characterised by dysphoria that occurs during milk release and lasts for several minutes. Symptoms include sudden and unpleasant feelings of anxiety, sadness, irritability or panic. The exact cause of DMER is not known. Studies suggest that the sudden drop in dopamine at the start of lactation causes a short-term dopamine deficiency in women, which can lead to dysphoria. It is known that women experiencing DMER have a negative process towards breastfeeding due to the uncomfortable feelings, and some women may stop breastfeeding or feel compelled to continue breastfeeding because of this discomfort. Although there is no medically proven treatment, it has been suggested that various non-pharmacological methods such as distraction, lifestyle changes, music and aromatherapy may be effective. As DMER has only recently been recognised, the literature is limited. The aim of this review is to present the current literature on DMER.

References

  • Ahmed, M., Mahmud, A., Mughal, S., & Shah, H.H. (2024). Dysphoric milk ejection reflex - call for future trials. Archives of Gynecology and Obstetrics, 310(1),627-630. doi: 10.1007/s00404-024-07503-4.
  • Beggs, B., Koshy, L., & Neiterman, E. (2021). Women’s Perceptions and Experiences of Breastfeeding: a scoping review of the literature. BMC Public Health, 21,2169. https://doi.org/10.1186/s12889-021-12216-3
  • Claesson, I.M., Larsson, L., Steen, L., & Alehagen, S. (2018). You just need to leave the room when you breastfeed Breastfeeding experiences among obese women in Sweden - A qualitative study. BMC Pregnancy Childbirth, 18(1),1–10. https://doi.org/10.1186/s12884-017-1656-2
  • Cox, S. (2010). A case of dysphoric milk ejection reflex (D-MER). Breastfeed Rev, 18(1),16-8. PMID: 20443435.
  • Deif, R., Burch, E.M., Azar, J., Yonis, N., Abou Gabal, M., El Kramani, N., & DakhlAllah, D. (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
  • Dukuzumuremyi, J.P.C., Acheampong, K., Abesig, J., Luo, J. (2020). Knowledge, attitude, and practice of exclusive breastfeeding among mothers in East Africa: A systematic review. Int Breastfeed Journal, 15(1), 70.
  • Francis, J, Mildon, A., Stewart, S., Underhill, B., Tarasuk, V., & Di Ruggiero, E. (2020). Vulnerable mothers’ experiences breastfeeding with an enhanced community lactation support program. Maternal Child Nutrition, 16(3),16. https://doi.org/10.1111/mcn.12957
  • Frawley, T., & McGuinness, D. (2023). Dysphoric milk ejection reflex (D-MER) and its implications for mental health nursing. International Journal of Mental Health Nursing, 32(2),620-626. doi: 10.1111/inm.13115.
  • Hacettepe University Institute of Population Studies. (2019, November). 2018 Turkey Demographic and Health Survey. Hacettepe University Institute of Population Studies, Presidency of the Republic of Turkey Presidency of Strategy and Budget Presidency and TUBITAK, Ankara, Turkey.
  • Heise, A.M., & Wiessinger, D. (2011). Dysphoric milk ejection reflex: A case report. International Breastfeeding Journal, 6(1),1-7. https://doi.org/10.1186/1746-4358-6-6
  • Isık, H., & Arca, G. (2019). The Role of Midwife and Nurse Regarding Breast Milk and Breastfeeding. Health Sciences University Journal of Nursing, 1(3), 221-228. https://dergipark.org.tr/tr/pub/sbuhemsirelik/issue/50916/605826
  • Kacır, A., Karabayir, N., Karademir, F., Basıbuyuk, M., Ocal, O., Buke, Ö., & Bilgin, D.D. (2024). Impact of Dysphoric Milk Ejection Reflex on Mental Health. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 19(7),547–553. https://doi.org/10.1089/bfm.2024.0055
  • Liu, H., Li, J., Li, X., & Lu, H. (2023). Dysphoric Milk Ejection Reflex: Report of Two Cases and Postulated Mechanisms and Treatment. Breastfeeding Medicine, 18(5),388-394. doi: 10.1089/bfm.2022.0206.
  • Moriyama, Y., Nakao, Y., &Yamamoto, N. (2024). Dysphoric milk ejection reflex among Japanese mothers: a self-administered survey. International Breastfeed Journal, 19, 21. https://doi.org/10.1186/s13006-024-00625-0
  • Skowrońska, K., Chmura, A., Baciur, P., & Środoń, A. (2022). Dysphoric milk ejection reflex as a new diagnostic and therapeutic challenge in lactation care - literature review. Journal of Education, Health and Sport, 12(11),48–53. https://doi.org/10.12775/JEHS.2022.12.11.006
  • Stacey AJ. (2020). Dysphoric milk ejection reflex. Breastfeeding Review, 28(1), 29-32. https://pubmed.ncbi.nlm.nih.gov/20443435/
  • UNICEF. (2019, October 14). Monitoring the situation of children and women. United Natıons International Children's Emergency Found. https://data.unicef.org/resources/dataset/sowc2019-statistical-tables
  • Ureño, T. L., Berry-Cabán, C. S., Adams, A., Buchheit, T. L., & Hopkinson, S. G. (2019). Dysphoric Milk Ejection Reflex: A Descriptive Study. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 14(9),666–673. https://doi.org/10.1089/bfm.2019.0091
  • Ureño, T.L., Buchheit, T.L., Hopkinson, S.G., & Berry-Cabán, C.S. (2018). Dysphoric Milk Ejection Reflex: A Case Series. Breastfeed Medicine, 13(1),85-88. doi: 10.1089/bfm.2017.0086.
  • Uvnas-Moberg, K., & Kendall-Tacket, K. (2018). The mystery of D-MER: What can hormonal research tell us about dysphoric milk-ejection reflex? Clinical Lactation, 9(1), 23-29. https://doi.org/ 10.1891/2158-0782.9.1.23
  • WHO, GBC, UNICEF. (2023, December). Global breastfeedıng scorecard 2023 rates of breastfeedıng ıncrease around the world through ımproved protectıon and support. https://www.unicef.org/documents/global-breastfeeding-scorecard-2023#:~:text=For%202023%20the%20scorecard%20demonstrates,target%20of%2050%25%20by%202025.
  • World Health Organization. (2020, August 12). Infants exclusively breastfed for the first six months of life. https://www.who.int/data/gho/data/indicators/indic ator-details/GHO/infants exclusively-breastfed-forthe-first-six-months-of-life
  • Zychlinsky S., AnnaCappenberg, R., IoannisGarcia G., JesusHapple C. (2025) Risk factors for dysphoric milk ejection reflex. American Journal of Obstetrics & Gynecology, 232(2), 37-39.
There are 23 citations in total.

Details

Primary Language English
Subjects Psychosocial Aspects of Childbirth and Perinatal Mental Health, Midwifery (Other)
Journal Section Review
Authors

Ayşe İrem Gökçek 0000-0003-2917-1439

Neslihan Özcan 0000-0003-1311-6646

Publication Date March 26, 2025
Submission Date July 18, 2024
Acceptance Date February 5, 2025
Published in Issue Year 2025 Volume: 8 Issue: 1

Cite

APA Gökçek, A. İ., & Özcan, N. (2025). Dysphoric Milk Release Reflex as A Problem in Breastfeeding Women. Journal of Midwifery and Health Sciences, 8(1), 76-80. https://doi.org/10.62425/esbder.1518151
AMA Gökçek Aİ, Özcan N. Dysphoric Milk Release Reflex as A Problem in Breastfeeding Women. Journal of Midwifery and Health Sciences. March 2025;8(1):76-80. doi:10.62425/esbder.1518151
Chicago Gökçek, Ayşe İrem, and Neslihan Özcan. “Dysphoric Milk Release Reflex As A Problem in Breastfeeding Women”. Journal of Midwifery and Health Sciences 8, no. 1 (March 2025): 76-80. https://doi.org/10.62425/esbder.1518151.
EndNote Gökçek Aİ, Özcan N (March 1, 2025) Dysphoric Milk Release Reflex as A Problem in Breastfeeding Women. Journal of Midwifery and Health Sciences 8 1 76–80.
IEEE A. İ. Gökçek and N. Özcan, “Dysphoric Milk Release Reflex as A Problem in Breastfeeding Women”, Journal of Midwifery and Health Sciences, vol. 8, no. 1, pp. 76–80, 2025, doi: 10.62425/esbder.1518151.
ISNAD Gökçek, Ayşe İrem - Özcan, Neslihan. “Dysphoric Milk Release Reflex As A Problem in Breastfeeding Women”. Journal of Midwifery and Health Sciences 8/1 (March 2025), 76-80. https://doi.org/10.62425/esbder.1518151.
JAMA Gökçek Aİ, Özcan N. Dysphoric Milk Release Reflex as A Problem in Breastfeeding Women. Journal of Midwifery and Health Sciences. 2025;8:76–80.
MLA Gökçek, Ayşe İrem and Neslihan Özcan. “Dysphoric Milk Release Reflex As A Problem in Breastfeeding Women”. Journal of Midwifery and Health Sciences, vol. 8, no. 1, 2025, pp. 76-80, doi:10.62425/esbder.1518151.
Vancouver Gökçek Aİ, Özcan N. Dysphoric Milk Release Reflex as A Problem in Breastfeeding Women. Journal of Midwifery and Health Sciences. 2025;8(1):76-80.

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