Dysphoric Milk Ejection Reflex: A Descriptive Study.

Introduction: Dysphoric milk ejection reflex (D-MER) is emerging as a recognized phenomenon to describe an abrupt dysphoria, or undesirable feeling that occurs with the milk ejection reflex (MER) and then goes away after a few minutes. The purpose of this study was to determine the prevalence of D-MER among breastfeeding women and to describe the experience of symptoms associated with D-MER. Materials and Methods: To determine the prevalence of D-MER, a retrospective chart review was conducted over a 12-month period on women presenting for their 6- to 8-week postpartum visit. To describe the experience of D-MER, an anonymous cross-sectional survey consisting of 36 items was made accessible through a link to an online survey management platform. Participants were recruited through both paper and electronic posters at a variety of venues. Results: A prevalence rate of 9.1% was found. The respondents described similarities in their experiences with D-MER, to include feelings coming on suddenly and lasting for <5 minutes. The respondents described feeling anxious, sad, irritable, panicky, agitated, oversensitive, and tearful most often. Conclusion: This is the first study to quantify a prevalence rate and describe suspected experiences of D-MER. It provides the groundwork for future research to explore other contributing factors or relationships that may be relevant to D-MER. The findings support that the experience of D-MER is different from that of postpartum depression. Future research exploring the behavior of hormones and neurotransmitters within the context of lactation could contribute to the knowledge regarding D-MER.

Dysphoric Milk Ejection Reflex: A Case Series.

BACKGROUND: Dysphoric milk ejection reflex (D-MER) is characterized by an abrupt dysphoria, or undesirable feeling that occurs with the MER and continues for no more than a few minutes. After milk ejection, the dysphoria vanishes. CASE SERIES: This case series provides a report of three women who have experienced D-MER. All three women described the sudden onset of negative feelings at the initiation of each breastfeeding session. The dysphoria vanished after each milk ejection. DISCUSSION: Literature on D-MER is limited to one published qualitative research study and two published case reports. As a result, lactation professionals and other providers in the healthcare setting rarely recognize this condition. CONCLUSIONS: The case studies presented here provide evidence for the presence of D-MER. Research is needed to better understand its pathophysiology, incidence, and treatment options.