Dysphoric Milk Ejection Reflex: Prevalence, persistence, and implications

Dysphoric Milk Ejection Reflex (D-MER), characterized by an abrupt wave of negative emotions during milk-letdown, affects a relevant proportion of lactating parents and may significantly impact feeding choices, but remains poorly understood.

We conducted a cross-sectional study using an online survey of lactating parents of children 18 months and younger who were nursed for any period of time.

The prevalence of D-MER in our cohort was 14.2 % (n = 209/1469). Among the 209 women who reported having experienced D-MER, the most frequently selected descriptions were: tense, hypersensitive, frustrated, irritable, overwhelmed, sad, lonely. In the D-MER group, 85.9 % (n = 158/184) used a pump to express breastmilk. Of these 57.0 % (n = 90/158) experienced milder or absent D-MER symptoms while pumping as compared to nursing. Only 5.7 %, (n = 9/158) reported more severe symptoms while pumping, and 12.0 % (n = 19/158) experienced symptoms only when pumping. 40.2 % (n = 72/179), of respondents with D-MER reported that their symptoms remained stable between birth and weaning. In 29.6 % (n = 53/179), symptoms became milder and in 9.5 % (n = 17/179) they disappeared. Importantly, 16.9 % (n = 30/177) of D-MER respondents stopped breastfeeding because of D-MER symptoms, and a further 19.2 % (n = 34/177) had considered doing so. The most frequently reported factor worsening D-MER symptoms was stress, which was selected by 62.1 % (n = 113/182), closely followed by lack of sleep (60.4 %, n = 110/182). Loneliness and conflict with a significant other were also frequently cited (49.5 %, n = 90/182 and 48.9 %, n = 89/182, respectively). The factors most likely to ease D-MER symptoms were "support from partner" and "sleep" (34.6 %, n = 63/182 and 29.7 %, n = 54/182, respectively).