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.

Let's talk about breast cancer screening guidelines.1) Standard breast cancer screenings begin with an annual mammogram ...
09/05/2026

Let's talk about breast cancer screening guidelines.

1) Standard breast cancer screenings begin with an annual mammogram when you turn 40.

2) Dense breast tissue changes the screening recommendations. About 40% of women have dense breasts. Mammography misses 20% of cancers in dense tissue, unlike MRI. Ask your doctor: "What's my density?"

3) Annual breast MRIs are indicated for women who:
- have ensity Class C or D (look at your mammo report for this)
- BRCA1/2 positive (or high-risk family)
- Prior chest radiation (Hodgkin's)
- Lobular carcinoma in situ (LCIS) history
- 20%+ lifetime risk (Gail/Tyrer-Cuzick)
- Personal history of breast cancer

4) MRI does not replace mammogram. MRI is supplemental, not standalone. Combine with mammography for best detection.

5) Talk to your doc about YOUR risk profile. Dense tissue? Family history? Personal history? That changes the plan.

Get screened. Stay informed.

ACR guidline update:

https://linkinghub.elsevier.com/retrieve/pii/S1546-1440(25)00498-3

09/03/2026

As an integrative physician, I focus on preventative cardiology, rather than waiting to treat symptoms. This is because cardiac disease begins long before symptoms appear, making early intervention far more effective. Heart disease is usually decades in the making!

I look at my patients' LDL, cholesterol particle size, lipoprotein-a, apolipoprotein-b: these lipid markers that can show me the risk of heart attack and stroke. Based on what I see in lab results, we may do imaging, like a CIMT (an ultrasound of the carotid arteries), or a calcium score of the heart, which looks for hard plaque, or even a CCTA with Cleerly, which looks for soft plaque.

There are many ways to assess someone's risk for heart disease before symptoms manifest.

08/31/2026

If you're doing the same workout you did at 35, we need to talk.

The weight you're lifting needs to feel heavy. In menopause, light weights and high reps are not the move for building muscle or protecting bone.

Estrogen is a potent anabolic signal — when it drops, you lose that baseline muscle protection. You need progressive overload: the weight must increase over time or you're maintaining, not building. Compound lifts — squats, deadlifts, hip hinges, overhead press — recruit the most muscle and load the most bone.

Mechanical loading of bone (impact + resistance) is the stimulus for osteoblast activity — cardio alone does not do this!

Aim for 3–4 sets of 6–10 reps at RPE 7–8 — you should be working hard!



08/28/2026

As an integrative physician, I work intensively with my patients on lifestyle and diet, but sometimes people can benefit from extra support. I love to stay abreast of the latest research in longevity medicine, and I'm particularly excited about two medications.

Retatrutide is slated for FDA approval in early 2027, and it's another medication that affects the GIP, GLP, and glucagon receptors. But compared to other GLPs, the retatrutide data is remarkable! With a small dose of 0.5mg, we see a 5% reduction in fat mass, specifically in visceral belly fat, which presents the most disease risk. In higher doses, a 4mg dose reduces fat mass by 15%, an 8mg dose reduces fat mass by 26%, and interestingly, a 12mg dose only reduces fat mass by 23%, so more is not automatically better.

The second medication I'm excited about is Lipfendra. Similar to Repatha, it reduces LDL ("bad" cholesterol), which helps prevent heart attack and stroke, but it's an oral medication instead of an injection. Repatha has historically been difficult to get, and now we have hope that Lipfendra may be a great alternative to statins. More research is needed, but I'm excited about the potential of both Lipfendra and Retatrutide as longevity medications.

08/24/2026

Estring: the v*ginal ring most people have never heard of. Think of its use as comparable to v*ginal estradiol cream. It's a flexible silicone ring, about the size of a diaphragm, that you insert yourself and forget about for three months. It delivers a steady, low dose of estradiol straight to the v*ginal tissue—treating dryness, painful in*******se, and cutting the risk of recurrent UTIs—without raising estrogen levels enough to need progesterone alongside it.

It won't touch hot flashes or night sweats, since it's built to stay local, but for genitourinary symptoms it's one of the lowest-effort options available. Ask your doctor if it's covered before you commit; insurance coverage is hit or miss, and the cost tends to be higher than patches/gel.

There's an unexpected connection between gut bacteria and mental health.Trillions of gut bacteria communicate with the b...
08/20/2026

There's an unexpected connection between gut bacteria and mental health.

Trillions of gut bacteria communicate with the brain through neural, endocrine, and immune pathways. The gut biome shapes cortisol receptivity, and gut bacteria can produce GABA, serotonin, and dopamine, linked to neurotransmitter production.

Patients with mental health conditions including PTSD, bipolar, schizophrenia, autism, Alzheimer's, Parkinson's, anxiety, and depression, show distinct microbiome signatures.

A Mediterranean diet has the strongest human data for mood of any microbiome-related intervention, including alongside antidepressants.
Fermented foods (kombucha, kefir, sauerkraut) and prebiotic fibers (leeks, asparagus, onion, chicory, banana) are also great food sources.

(sources: Butler MI, Mörkl S, Sandhu KV, Cryan JF, Dinan TG. The Gut Microbiome and Mental Health: What Should We Tell Our Patients? Can J Psychiatry. 2019;64(11):747–760)

08/18/2026

Let's talk about feeling hot in perimenopause. Your body's thermostat responds to fluctuations in estrogen. Temperatures that used to feel comfortable can suddenly become intolerable. This isn't indicative of a certain level of estrogen- it's the way your body responds to the fluctuations. For many people, hot flashes and night sweats can cause a lot of anxiety, especially if they interrupt sleep.

The good news? There are ways we can support temperature instability.
- Avoid triggers, like alcohol, spicy foods, and stress
- Get a bedside fan or cooling blankets
- Menopause hormone therapy can also help stabilize those fluctuations and lead to symptom relief

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.




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