27/08/2026
🌊You’re nursing and suddenly, just as your letdown comes, you are hit with the most horrible wave of emotions. You may feel lost and alone, gross and disgusting, or profoundly angry and irritated. Within a few minutes, the feelings resolve. Only to happen again the next feed.
This phenomenon is known as DMER, (Dysphoric Milk Ejection Reflex), and can profoundly affect your breastfeeding journey and mental health surrounding nursing. If you’re reading this in search of answers today, mother, you are not crazy, and you’re not alone.
Why do some women have these terrible feelings when their milk lets down? We don’t have clear reasons and answers, but we have some theories. When your milk starts flowing, it’s triggered by what is called the milk ejection reflex. Dopamine levels dip, and oxytocin levels increase. The two major theories are that either these feelings may be triggered by a greater than normal drop in dopamine, or a higher than usual spike of oxytocin.
🌊”D-MER is not a psychological response to breastfeeding. It is a physiological response to milk release.” - Dmer.org 🌊
Luckily having these feelings does not mean you hate breastfeeding, or your baby, or yourself! It’s not a reflection of your total mental health, or bodily health, or whether you are feeding your baby well or not. It is simply a physiological “anomaly” that happens to feel bloody terrible!
Common DMER feelings with letdowns include:
- Feeling icky or gross
- Feeling nauseous
- Nostalgia and feelings of homesickness
- Feeling hopeless or like a failure
- Feeling depressed or anxious
- Feeling an intense need to disappear or run away
- Intense feelings of guilt
- Thoughts of self harm or self loathing
- Anger or rage
- Irritation or feeling “itchy”
Some mothers experience neuropathic pain of the ni**le or breast along with negative feelings upon letdown. This manifests as excruciating ni**le or breast sensations of burning, tingling or pressure. The mechanism of why only some women experience DMER with neuropathic pain is not fully understood, and may have to do with alterations in serotonin receptors and possible inflammation and blood flow changes in the ni**le.
So how do we fix this? Can we?
DMER is controlled by hormones and not by your thoughts or actions, so simply “thinking” yourself out of the negative feelings isn’t possible. There is also no known “cure” for DMER. But in managing DMER and making it more bearable we can look at physical and mental support respectively.
🌸 It is worth noting that the most severe episodes of DMER often happen in the first 3 months, and many mothers find the intensity tapering off significantly at 6 months, 9 months and after a year. However, in severe cases it may continue past a year.
🌸 Adequate rest and longer stretches of sleep (especially a 4 hour “anchor stretch” can make a difference in how intense the sensations feel, and may eliminate some episodes entirely if the “sleep bank” is fuller. (With very young babies this may be challenging and outside support to help should be considered). If night time sleep can’t be stretched, naps during the daytime can provide relief.
🌸 Cutting down on caffeine.
🌸 Nutritional support : Vitamin B and D, Magnesium and probiotics have evidence in supporting the hormones and mechanisms involved with DMER. Avoiding low carb diets, and increasing protein intake can be helpful, which can help stabilise blood sugar levels and insulin release. Checking for iron deficiency is also worth looking into as low iron can create a host of mental health effects.
🌸 “Self care” time may make all the difference. Feeling emotionally vulnerable, “touched out” or isolated can impact the severity of the emotions upon letdown.
🌸 Avoiding dopamine antagonists often prescribed as galactogogues like domperidone, and medication that increases prolactin levels.
🌸 Medication that has an impact on hormones like birth control can contribute to severity, as well as hormonal changes around ovulation and menstruation.
🌸 Long stretches between feeds and overfull breasts can also exacerbate the symptoms.
🌸 In severe cases your Dr can prescribe a SSRI to help stabilise the hormones involved. If you are unbearably affected by this condition, reach out for support.
Coping techniques :
🌴 distraction : scroll social media, read a book or ebook, listen to music, watch television
🌴 physical movement : curl your toes, flex your leg muscles, relax your shoulders and jaw, bite something, play with your hair
🌴 breathwork : deep breathing techniques and meditation
🌴 drinking ice water during letdowns
🌴 snacking on something tasty or mood boosting like chocolate
🌴 reducing mental load : decluttering the nursing space and outsourcing household tasks to create a relaxed atmosphere that doesn’t contribute to stress and feelings of unease
🌴 focusing on your baby and your great love for them ❤️
As one mom living with DMER shared with La Leche League South Africa -
“I've never approached D-MER as something emotional - it has helped me to view it like any other bodily symptom that can be supported with the diet, sleep and exercise that most mental health problems benefit from! I don't give those empty feelings the time of day. They're not me, they're not a part of me, they're just a symptom I get when my body needs extra support. As much as someone else can counsel me or listen to how bad it is, I can support myself by taking care of myself.
With D-MER and especially through multiple ages and phases with multiple babies having a running and ever-adapting plan is needed. Know it may pass. Know it may not. Know you're not doing anything “wrong”. Know the more supported your body is physically, and you yourself emotionally, the better you can weather the letdown challenges.
Know whatever you’re feeling while nursing, your baby is only feeling the warmth and great love and joy that you nursing them brings.”
❤️🌊
PerleMama Lactation, Annette Nel LC (CBI). 2026
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https://www.lllsa.org/dysphoric-milk-ejection-reflex?fbclid=IwcGRvZgRleHRuA2FlbQIxMQBzcnRjBmFwcF9pZA80Mzc2MjYzMTY5NzM3ODgAAR6qw_jddPY5IY63dbb1YmL--gMCbrmfWJulj10JU5w_MT6muI1Olm3KMJvJ7w_aem_qOfc9YdamyijCdLqH6hd3A
https://physicianguidetobreastfeeding.org/mythbusters/horrible-ni**le-pain-dnss-dmer/
https://d-mer.org/helps-and-hinders
