The experience of breast pumping can be accompanied by unexpected and intense feelings, ranging from physical discomfort to a sudden shift in mood. Many people describe this as feeling “off,” “weird,” or emotionally agitated. These sensations are deeply rooted in the complex biological and mechanical processes required to express milk. Understanding the underlying hormonal shifts and equipment nuances helps explain why this common experience occurs.
The Physiology of the Milk Ejection Reflex
Milk release is governed by the neuroendocrine event known as the milk ejection reflex, often called the “letdown.” This process requires two main hormones: Prolactin is responsible for milk production, while oxytocin triggers the ejection of the milk.
Tactile stimulation prompts the brain to release oxytocin from the posterior pituitary gland. Oxytocin causes the myoepithelial cells surrounding the alveoli to contract, squeezing milk down the ducts toward the nipple. This rapid physical contraction creates the sensations felt during letdown, which can include a sudden rush, pressure, or tingling.
Understanding Dysphoric Milk Ejection Reflex
The hormonal surge of letdown can trigger a distinct emotional reaction known as Dysphoric Milk Ejection Reflex (D-MER). This is a physiological condition characterized by a brief but profound drop in mood temporally linked to the milk ejection reflex. Symptoms typically begin just before the milk starts to flow and resolve quickly, usually lasting 30 seconds to a few minutes after letdown begins.
People experiencing D-MER report negative feelings, including dread, sadness, agitation, anxiety, or a hollow feeling. The suspected neuroendocrine cause involves a sharp, temporary drop in the neurotransmitter dopamine, which regulates mood and pleasure. While oxytocin is released to trigger letdown, it also suppresses dopamine; an overly rapid dip in dopamine levels is believed to cause the brief dysphoric feelings. This condition is estimated to affect between 5% and 15% of lactating people.
Physical Discomfort and Equipment Factors
Mechanical and fit issues with the pump contribute significantly to feeling “weird” by causing physical pain and stress. The breast shield, or flange, is the cone-shaped part that goes over the nipple, and an incorrect size is the leading cause of discomfort. A flange that is too small causes the nipple to rub painfully against the tunnel, leading to friction or damage. Conversely, a flange that is too large can pull too much of the areola into the tunnel, resulting in a sharp, pinchy feeling as the tissue gets trapped.
Setting the pump suction level too high is another common mistake, often based on the idea that stronger suction yields more milk. Excessive vacuum pressure can compress milk ducts, cause pain around the areola, and result in tissue damage. Beyond physical pain, being attached to a noisy machine for extended periods can cause psychological stress and sensory overload. The feeling of being tied down by tubing and the time commitment necessary can negatively color the entire process.
Strategies for Managing Pumping Sensations
Managing the sensations that arise during pumping involves addressing hormonal responses and optimizing mechanical equipment. For D-MER, simple coping mechanisms often provide relief, such as using distraction by watching a show or reading a book during the brief period of dysphoria. Tracking symptoms and ensuring adequate hydration and sleep helps mitigate the intensity of the mood drop.
In cases of severe D-MER, consulting a healthcare provider may be helpful, as medications that increase dopamine levels provide relief. For mechanical issues, the first step is having a professional lactation consultant check the flange fit, since nipple size can change over time. Adjusting pump settings to the lowest comfortable suction level prevents tissue trauma, and applying lubrication to the flange tunnel reduces friction. Incorporating deep breathing or mindfulness techniques can help manage the physical discomfort and psychological stress associated with the routine.