It’s common for new moms to experience pain or discomfort when their milk lets down. This is known as Dysphoric Milk Ejection Reflex (D-MER). Let’s explore what causes letdown pain and what you can do about it.
What is letdown?
Letdown, also called milk ejection reflex, occurs when your brain sends signals to your breasts to release milk. This often happens in response to your baby sucking, but can also occur from hearing your baby cry, thinking about your baby, or feeling relaxed after a warm shower.
During letdown, you may notice:
- Tingling, stinging, burning or tightness in the breast
- Milk leaking or spraying from the breasts
- Uterine cramps
Letdown helps transfer milk from the alveoli (milk-making cells) down the milk ducts toward the nipple so your baby can feed. This process is controlled by the hormones prolactin and oxytocin.
What causes letdown pain?
Letdown pain or discomfort is often caused by oxytocin. When your brain sends the signal to release milk, it also releases oxytocin into your bloodstream. Oxytocin causes the milk ejection reflex, but it can also lead to uterine contractions.
These oxytocin-triggered contractions can feel similar to mild labor contractions or menstrual cramps. The discomfort is usually brief, lasting 30 seconds to 2 minutes. However, in some women it can be severe and last longer.
Researchers believe D-MER may be caused by a sudden drop in dopamine levels triggered by oxytocin release. Dopamine is a “feel good” hormone involved in emotional responses. A quick dopamine drop can make you feel sad, anxious, irritable or “blue” for a short time.
When does D-MER occur?
D-MER symptoms typically begin within 1-5 minutes after letdown starts and resolve once milk flow slows again. The intensity and duration can vary from mother to mother.
Episodes tend to occur with the first letdown of a feeding session. Some moms only experience it on the first feeding of the day, while others feel it with every letdown.
Common D-MER symptoms
Along with physical discomfort, D-MER can cause an array of emotional and mental symptoms for a short time, such as:
- Sadness
- Anxiety
- Irritability
- Agitation
- Panic
- Dread
- Detachment
- Feeling overwhelmed
Physical symptoms may include:
- Nausea
- Dizziness
- Clamminess
- Headache
- Intestinal cramps
- Flushing
- Chills
- Weakness/fatigue
Risk factors for D-MER
Research is still limited on why some women experience D-MER and others don’t. Potential factors include:
- Hormonal imbalances
- Genetics
- Birth trauma
- History of anxiety, depression or OCD
- Thyroid issues
The following women may be more prone to D-MER:
- First-time moms
- Moms who had long/difficult labors
- Moms with Polycystic Ovarian Syndrome (PCOS)
- Moms with low progesterone
- Those with hyperthyroidism or hypothyroidism
However, D-MER can affect any breastfeeding mom. Even women without risk factors can experience it. The cause is still unknown.
Will D-MER affect my milk supply?
For most women, D-MER does not impact milk production. The hormones are still signaling your breasts to release milk normally.
However, if the discomfort is severe, it may make you hesitant to breastfeed. You may start limiting or skipping feedings to avoid triggering D-MER episodes. Rarely, the stress hormone release may also inhibit milk ejection reflex.
If D-MER is causing you to breastfeed less often or for shorter durations, it can gradually decrease your supply. Make sure you are feeding your baby adequately and watching for signs of low milk supply like:
- Baby seems hungrier than usual
- More frequent feedings
- Diapers less wet
- Poor weight gain
Treatments for D-MER
If you experience mild D-MER symptoms occasionally, you may not need treatment beyond moral support. But if episodes are frequent or severe, the following remedies may help provide relief:
Medication
Your doctor may prescribe fluoxetine, a selective serotonin reuptake inhibitor (SSRI). SSRIs can help stabilize serotonin and dopamine levels.
One study found that low-dose fluoxetine reduced D-MER symptoms in 85% of mothers. However, SSRIs do transfer into breastmilk and can affect baby.
Supplements
Some moms find relief from natural supplements that support dopamine levels, like:
- Vitamin B6
- Vitamin D
- Magnesium
- Probiotics
Always consult your doctor before taking new supplements while breastfeeding.
Relaxation techniques
Techniques to induce relaxation can help minimize anxiety and discomfort from letdown. Try:
- Deep breathing
- Meditation
- Calming music
- Guided imagery
- Affirmations
Practice daily to enhance the calming effects. You can even use these techniques right before breastfeeding to put yourself in a relaxed state before letdown.
Acupuncture
Getting acupuncture treatments may reduce D-MER symptoms. Acupuncture can adjust oxytocin levels, support dopamine, and induce relaxation. Make sure you see an acupuncturist experienced in pregnancy and lactation.
Counseling
Talking to a mental health professional can provide coping strategies for the emotions triggered by D-MER. Counseling may also uncover and address any underlying issues, like trauma, that could be contributing to symptoms.
Tips for coping with letdown discomfort
Along with specific treatments, the following tips can help you manage the pain and emotions of D-MER:
- Stay hydrated and eat regular, balanced meals
- Get enough rest
- Reduce stress
- Accept the feelings knowing they are temporary
- Remind yourself the discomfort will pass
- Focus on your baby during letdown
- Talk to a lactation consultant
- Join a support group to share experiences
Does D-MER go away?
For most moms, D-MER resolves over time, especially once breastfeeding is well established. As your body gets used to breastfeeding, the intensity of letdown sensations usually decreases.
However, some women continue to experience symptoms for the entire duration of breastfeeding. The discomfort may fade, but never fully resolves.
If D-MER is severely impacting your ability to breastfeed or mental health, discuss medication options and early weaning with your doctor. While not ideal, switching to pumping or formula may be necessary in severe cases.
When to see a doctor
See your physician if:
- Symptoms don’t improve after 2 weeks
- Discomfort interferes with feeding
- You’re experiencing signs of depression
- It affects your ability to function
Sudden, severe breast pain could also indicate a serious health issue like an infection. Seek medical care immediately if you have symptoms like:
- Red, swollen, painful breast
- Flu-like fever or chills
- Hard, red streaks on the breast
Conclusion
Dysphoric milk ejection reflex is a common cause of letdown discomfort. While the sensations are usually temporary, they can be quite unpleasant. Don’t hesitate to seek help if D-MER is affecting your breastfeeding experience or mental health.
With the right treatment plan, most moms find their symptoms resolve or become manageable over time. Staying relaxed during letdown, caring for your health, and focusing on your baby can all help you push through the tough moments.