Dr. Malia Swanson

Dr. Malia Swanson Welcome! I’m a board-certified family medicine physician and a certified menopause expert with The Menopause Society. https://linktr.ee/dr_malia_swanson

I’m passionate about educating and supporting women during the perimenopause transition and beyond.

08/16/2026

Patients frequently ask if there are natural ways to increase their testosterone levels. When men improve their diet, sleep, and exercise, this can significantly increase their testosterone levels. But in women, those same interventions tend to decrease testosterone.

The one thing that can increase testosterone in women is exercise, and this increase is only apparent during the exercise itself-usually an average increase of about twenty percent.

08/13/2026

How do you know if you're on enough testosterone? We're looking for improvements in focus, concentration, motivation, and energy, as well as muscle gain and increased libido.

I take all of these elements into consideration when I'm titrating a patient's testosterone dose.

The climb up Lynx Pass was all burning legs and wildflowers spilling down the hillside. The kind of hard-and-beautiful ...
08/07/2026

The climb up Lynx Pass was all burning legs and wildflowers spilling down the hillside. The kind of hard-and-beautiful that reminds you why we keep showing up.

Here's what I tell my patients, and what I live myself: midlife isn't the wind-down. The years around menopause are exactly when the work matters most: building strength, protecting muscle, staying in hard efforts that keep the body and brain resilient for decades. Every season I line up a little stronger than the last, not to chase a time, but because use it or lose it is real, and I plan on using it for a long time.

Get outside. Push a little past comfortable. Grow year over year. That's the longevity prescription.




08/07/2026

Why would someone begin MHT before her cycle stops, vs. beginning hormone therapy after the final menstrual period, when hormones are low?

Menopause hormone therapy is straightforward in someone who's already postmenopausal, because you're just providing progesterone and estrogen to someone who already has low levels of those hormones: raising a relatively flat baseline hormonal level.

But when we give MHT to someone who's still cycling, we support the baseline estrogen level so estrogen levels aren't bottoming out. This reduces the body's tendency to compensate by increasing FSH levels. If someone in perimenopause is having symptoms of flaring estrogen, it's easy to wonder why they would benefit from adding more. But by supporting the hormonal baseline, we actually decrease the overall perimenopausal estrogen burden, by signaling to the brain that it doesn't need to spike those estrogen levels to compensate for the troughs.

08/04/2026

Women begin menopause hormone therapy for two main reasons:

1) Menopausal symptom management
2) Disease prevention: menopause hormone therapy can provide significant health benefits, including reduced risk of colon cancer, diabetes, and osteoporosis. There's good evidence around its benefits for reducing cardiovascular disease and cognitive decline when started within 10 years of last menstrual period, or under the age of 60.

However, that reduced disease risk is only present as long as you're on hormone therapy. Once you stop taking hormone therapy, your disease risk returns to baseline.

So why do some providers say women should be on hormone therapy for the shortest possible time?

Studies involving medroxyprogesterone acetate, a synthetic progestin hormone, did show an increased risk of breast cancer after six years of use-but we're not using that anymore. Now we use micronized progesterone. While we don't have large randomized controlled trials on micronized progesterone in isolation, it has not shown the same breast cancer risk in smaller trials.

The E3N cohort followed nearly 80,000 French women over 8+ years. This is not a randomized controlled trial, but one of the largest and longest observational datasets we have on hormone therapy and breast cancer by progestogen type. The same cohort finds no duration-dependent breast cancer signal for micronized progesterone across multiple independent analyses.

For this reason, menopause specialists have moved towards a more long-term outlook when it comes to hormone therapy.

What are plant sterols, and how do they affect cholesterol? Plant sterols are natural compounds found in the cellular me...
08/02/2026

What are plant sterols, and how do they affect cholesterol?

Plant sterols are natural compounds found in the cellular membranes of plants. They can help lower your LDL ("bad" cholesterol), which helps reduce your risk of heart disease and stroke.

Because their molecular structure is so similar to human cholesterol, they compete for, and effectively block, cholesterol absorption in the gut. This helps lower LDL, which reduces your overall risk.

To successfully lower LDL by 7-12%, adults need between 2-3g (2,000-3,000 mg) daily. Plant sterols are naturally present in many foods, like vegetable oils, seeds, nuts, whole grains, and legumes. However, dietary sources usually contain amounts that are too small to make a significant difference in your cholesterol levels. This is why many people supplement with plant sterols (in addition to adopting a heart-healthy diet).

Before taking any new supplements, talk to your doctor.

08/01/2026

A lot of my menopause patients complain about rage. Before becoming a menopause specialist, I used to call this depression or anxiety. But there's a diagnostic code specifically for rage and irritability! This is a separate complaint, and you should feel confident talking to your doctor about ways to address your irritability.

So why do perimenopausal and menopausal women feel this rage? Progesterone is metabolized to allopregnanalone, which affects the GABA receptors in the brain-the neurotransmitters that help you feel calm and relaxed. As progesterone declines in perimenopause, irritability can become more prominent.

Post-menopause, when estrogen is low, we tend to see rage level out, although for some women, rage hangs on. There's also likely a cultural component at play. Many of us reach a point where we're simply fed up with what's going on in the world, but rage has a strong hormonal component as well.

07/31/2026

The estrogen patch shortage is making life difficult for so many of my patients! Supply is intermittent and unpredictable, and it's taking my patients a lot of work to try to track the patches down. Due to the patch shortage, I'm switching a lot of my patients to estradiol gel, which can be applied daily to the arms or the thighs. Insurance tends to cover estradiol gel, but if it doesn't, it's still pretty affordable: about $30 cash-pay.

There are other forms of estradiol, too, including compounded creams, estradiol sprays, and as a last resort, injectable estradiol. Your provider should be working with you towards creative solutions to keep you on your estrogen, even during the patch shortage.

07/28/2026

Perimenopause isn't just "low hormones," it's actually the most volatile hormonal period of your life. Higher highs and lower lows of estrogen than you've ever experienced, with progesterone dropping first and your body essentially screaming at your ovaries to keep up.

That chaos you're feeling? It's not in your head. It's FSH flooding your system trying to force hormone production that your ovaries can no longer sustain consistently.

The good news: postmenopause brings stability. But the transition deserves more than being dismissed as "just getting older."

If perimenopause symptoms are disrupting your life, you don't have to white-knuckle through it. Hormone therapy works — and starting it during this window matters.

Your hot flashes might be a metabolic signal, not just a hormonal one. new research followed approximately 3,000 women f...
07/27/2026

Your hot flashes might be a metabolic signal, not just a hormonal one. new research followed approximately 3,000 women for a decade (the SWAN study). It found that higher insulin at age 47 predicted earlier onset of hot flashes and night sweats. Higher insulin also meant temperature instability that lasted longer. Insulin was a stronger predictor than BMI, once other factors were controlled for.

Why this matters: insulin resistance may affect your body's temperature control center, independent of estrogen withdrawal. This may reframe hot flashes / night sweats as partly metabolic.

The upside: insulin often improves with exercise, even before weight does. Movement may be treating your hot flashes more than you think!

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