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Dealing With D-MER | Dysphoric-Milk Ejection Reflex

Uncategorized Jun 28, 2020

This post comes from my podcast, Motivation For Moms episode 70, entitled "Dealing With D-MER | Dysphoric-Milk Ejection Reflex." To listen to this podcast episode on iTunes, click here. Be sure to subscribe to Motivation For Moms to get the latest show episodes as they are published, and please write a review, which is the ultimate gift to me.

Well hey there. I have a really interesting topic for today, I will warn you, it’s definitely not one of my usual motivational / personal development topics, BUT, it’s something that is something very important to me to share, and you might find fascinating, or possibly even learn something about yourself today. It’s something that is not very well known about. Most of the medical community doesn’t know about it, even in the holistic health community, but it’s something very real, and affects a LOT of moms, specifically, moms who are breastfeeding or lactating. Today I want to discuss D-MER, which stands for Dysphoric Milk Ejection Reflex, it’s a phenomenon where the mom experiences an awful feeling just before having a letdown. It’s NOT postpartum depression, and is often completely mismanaged by the medical community because they simply don’t have an understanding what it is yet. I have personally experienced this condition while breastfeeding all three of my kids now, and, I’ll be honest, it’s really, really hard to live with. But…. I’ve found ways to cope and I’d love to share with you my experience today. I’m also going to introduce you to the go-to D-MER expert, Alia Macrina Heise, who wrote the book about D-MER. I got to have a conversation with her, which I am going to share with you. I hope that you learn something from this episode, even if you’ve never had D-MER, and if this is something you think you have, or you’ve had in the past, then I hope you can get some understanding from this very special Motivation For Moms episode. Ok let’s dive in.

Today I wanted to introduce you to something that is close to my heart because it’s something that I have struggled with while breastfeeding all three of my kids, and that is D-MER.

With my first two girls, I breastfed them until they were 20 months, and I now am going through it again with my 6 week month old, so when you add that up, I have had D-MER for over 41 months of my life. If you think of that in terms of years, that is nearly 3 and a half years dealing with this incredibly difficult condition. It’s not something I talk about often, I don’t think I’ve ever mentioned it on the show, because, it’s honestly just such a difficult and private part of my life, but now that I’m going through it again, I wanted to muster the courage to talk about it, in hopes that it helps someone else.

So D-MER, stands for Dysphoric Milk Ejection Reflex. Basically what happens, for me, is just before having a letdown, I get an overwhelmingly horrible feeling, like the world is ending, or like, I’ve just seen the most disturbing thing of my life, coupled with horrible nausea and a pit in my stomach, and then, it goes away, and I have a letdown. The good news is, the feeling only lasts a few second, sometimes 20 or 30 seconds, and then it goes away. The bad news is, because let downs can happen several times during a feeding session, and letdowns also happen spontaneously throughout the day, that means that it’s happening a LOT, and, it’s impossible to predict when it’s going to hit. So I could be sitting there admiring my baby and all of a sudden it hits me. I could be hanging out with kids, or my husband, or my best friend, and all of a sudden, it hits me. I could be sitting down eating dinner, and all of a sudden, it hits me, and when it hits, like I said I get a deep pit in my stomach, and so I can’t eat, while it’s happening. The sucky part is, that it can turn anything I was thinking about, into a horrible thought. So for example, I could be sitting there planning my husband’s birthday party, and all of a sudden, it hits, and I start thinking about all of the things that could go wrong. Or I could be sitting there playing with my kids, and all of a sudden, it hits me, and I start thinking about all of the things I’m doing wrong. It’s like a disease that turns everything dark. But again, only for a few seconds, and then it goes away.

So the question is, what the heck is this D-MER, what causes it, and what can be done about it? I first discovered D-MER back in 2013 when my first daughter Audra was born. I guess it must have been 2014 though, because my daughter was born at the end of 2013 and it must have taken me a month or two to notice and realize that something was going on. To be honest, I didn’t even know what letdown was when I first started breastfeeding. But once I learned about letdown, and I started to notice these horrible feelings just out of the blue, and then I connected the dots and realized that it was happening just before a letdown, I did some research. I think I type in something like, “anxiety during breastfeeding” or something to that effect. And that’s when I found the website,, created by the expert, and co-discoverer of the condition, Alia Macrina Heise. When I started reading about it, I realized that that was exactly what was going on. It wasn’t postpartum depression, because other than when the D-MER was actually hitting me just prior to a letdown, I was perfectly fine, in fact, I was thriving, and totally enjoying the early newborn days. It wasn’t general anxiety, because again, it seemed so specific to just prior to a letdown. Alia Macrina Heise, as I mentioned, is the go-to expert in D-MER, she wrote the book, Before the Letdown: Dysphoric Milk Ejection Reflex and the Breastfeeding Mother, and has spearheaded much of the little research available about this phenomenon.

My plan, was to bring Alia on the show today to have her tell us all about D-MER and what is currently known about it. We got on a call, we started having some technical difficulties, and unfortunately, I was not able to successfully record our entire conversation, and to be honest I’m super bummed about that, but, because I’m a mama who figures it out, like you, I committed to still getting the episode out, even if I couldn’t have Alia actually on the show. So here’s what I’m going to do. If this is something that you think you’ve had or you have, or you are in the field of lactation, or you just want to know more about D-MER, I’m going to ask you to consult the D-MER website, which is, get her book, Before the Letdown: Dysphoric Milk Ejection Reflex and the Breastfeeding Mother, and, to get support, you can join the Facebook group, which is Dysphoric Milk Ejection Reflex (D-MER) Support Group from

Here’s what I’m going to attempt to do in this episode. I want to share with you from my own experience what I’ve learned about D-MER, why it happens, how to live with it, and if there is any hope for relief.

So from what I understand after talking to Alia and reading her book, is that there seems to be a connection between D-MER and dopamine in the brain. Remember, dopamine is one of those feel good chemicals in the brain that is interconnected with many physiological responses in the body, such as, having a letdown. See, in order to have a letdown, your body has to pull some levers and push some buttons so to speak, and one of those levers must drop dopamine, so that oxytocin can rise, and a letdown can occur. In moms who experience D-MER, they suspect that the mother simply is having an inappropriate drop in dopamine, and since dopamine is a feel good chemical, when it drops, she feels utterly terrible. So as it’s currently understood, this is a physiological, meaning physical, occurrence with emotional symptom, not a symptom of an emotional condition. In other words, what D-MER is not, is it’s not postpartum depression, although it’s often treated as such, and it’s not also not thought to be a symptom of trauma, which was my initial thought when I realized that I had this condition, or phenomenon or whatever you call it. I wondered if breastfeeding, or nipple stimulation, was triggering unprocessed trauma, causing this several emotional and physiological reaction, but from the research that Alia and her team have done, this doesn’t seem to hold up.

I’ve already mentioned my experience with D-MER, it feels like the world is ending, I feel like I’ve just seen something horrible, or like something horrible is happening, I feel incredible nauseous and have a severe aversion to food, and it just feels like the world is caving in on me. But not all moms who have D-MER feel the exact same. In fact, on her website,, Alia breaks D-MER symptoms into three categories: despondency, anxiety, or agitation, and within those categories, the symptoms can range from mild to severe. Now how long can a lactating mother expect it to last? The website also says that mild cases often self correct in the first 3 month, moderate cases by month 9 and severe cases sometimes does not correct until after the first year or later. For me, I definitely fall within the anxiety category, on the severe end of the spectrum.

Some moms have D-MER with some babies and not others, I had it with all three of my kids so far. And as of recently, I’ve noticed in the D-MER Facebook group, more and more women reporting feeling D-MER during pregnancy, which I will also attest, in the third trimester of this last pregnancy and I definitely did too, which is strange since I didn’t experience the letdown associated with it, and this definitely brings up many questions for me about what’s going on in pregnancy.

So what can be done? Although there is no proven solution to helping with the D-MER symptoms, some moms have reported various things working for them. In other words, there is anecdotal evidence to suggest that there could be possible remedies to, at the very least, improve symptoms. I met with a naturopath when my middle daughter was a baby, right when I was in the middle of it. And it didn’t surprise me that she hadn’t heard of it, but she did work with her colleagues to come up with a few things that could possibly boost my dopamine levels. One of them was an herbal supplement tincture that was a blend of different herbs, and the other was her recommendation to start taking rhodiola, and to increase the B-Vitamins.

When I spoke with Alia, she seemed very excited to tell me about the research being done right now between the similarities between D-MER, and Post-Coital Dysphoria, which is basically, post-orgasm dysphoria, and it’s interesting that the symptoms for this, and D-MER seem to be similar in some ways, and they’re trying to see if there are any similar underlying mechanisms to better understand both.

So for now, there are no definite answers, except, for the fact that D-MER sucks. No pun intended. I personally find it to be very intrusive in my daily life, especially now that I’m in the thick of breastfeeding and I’m having letdowns all day long. I’ll often have to stop a conversation, or stop what I’m doing, and just take a moment to process the horrible feelings that come, but then, they’re gone, and everything is back to normal. It really is a strange disease, or whatever you call it, I don’t know if it’s technically considered a disease yet, but I will say, there definitely is dis-ease when it come to dealing with this.

As hard as it is, one thing I know for certain is that we as moms sure put up with a lot. And, we keep going. I know that the challenges that are unique to moms, only make us stronger, as long as we have the will and determination to become stronger, to not let the pain and challenges of motherhood and life break us. That’s why, I believe moms are some of the most powerful beings in the universe, it’s exactly our pain and challenges that have made us that way. We have the ability to create and bear life. We have the ability to shape and raise humans, to nurture and nourish, to comfort those who are hurting, to foresee into the future, and, to bear more pain than anyone could even imagine. We are also human. And we must remember that as much as we nurture and nourish and love and care for those around us, we must do the same for ourselves. So if you are a mom who has had D-MER or is going through it now, please be kind to yourself. And this goes for all of you, even if you haven’t had it. Maybe you’ve had postpartum depression. Maybe you suffer from anxiety, or addiction, or loss and grief. Be kind to yourself. Love yourself. I love you. You are amazing, and I want to encourage you to keep going strong, do what you need to do to care and strengthen yourself, so you can show up as queen of your tribe and, be the woman you want to be and live the life you want to live. We can choose these things, even if life isn’t perfect, even if we experience pain.

One of my all time favorite sayings is an old Buddhist saying: pain is inevitable, but suffering is optional. No matter what it is that you’re going through, you have a choice of whether you are going to suffer. We don’t have to suffer. We can let our pain make us stronger, and more resilient, and more confident. I love you sister, and I am thinking of you right now, and always.

For more information on D-MER, go to, get the book, Before the Letdown: Dysphoric Milk Ejection Reflex and the Breastfeeding Mother, and, to get support, you can join the Facebook group, which is Dysphoric Milk Ejection Reflex (D-MER) Support Group from I really wish that Alia was on this episode to share with you everything she knows about D-MER, and I’m so bummed that technology failed us on our call, but one quote I want to leave you with is from her book, where she said:

"D-MER challenged and extended my emotional intelligence and my self awareness. It played on my highly sensitive nature and empathic personality. It pointed me in direction of mindfulness, forced me to better understand feelings of self shame, and after it broke me, it allowed me to build myself back up. Not everyone may be able to look back on their time spent hand in hand and heart in heart with D-MER, and feel a like it made a lifetime impact on their psyches. But I have no regrets for what life handed me when it handed me D-MER, and I have no doubt that the various personal details of my life, the ones from before and after D-MER, as well as the veracity of my D-MER itself, set me up to be the one to bring better understanding about D-MER to the field of lactation and to the mothers that it supports."

-Alia Macrina Heise, Before the Letdown: Dysphoric Milk Ejection Reflex and the Breastfeeding Mother (Amazon)