Supplementing with
creatine has long been done by professional athletes and those in the fitness world as a means of improving performance.
Extensive research has found it to be safe and effective, especially when used to enhance high-intensity activities. But use of these supplements has spread beyond athletes — and they may have other benefits, such as building muscle, reducing fat, and improving mood and cognition.
Evidence suggests that creatine supplementation could benefit women in perimenopause and menopause because it may help manage some of the common symptoms.
Creatine is a naturally occurring substance that is derived from three amino acids: arginine, glycine, and methionine.
It is naturally produced by the liver, pancreas, and kidneys — about 1 gram (g) of creatine per day, or about half of what your body needs.
The rest is supplied through
diet, especially in high-protein foods like red meat, seafood, and poultry.
Nearly all the body’s creatine (approximately 95 percent) is stored in your muscles, where it’s used for energy during physical activity. The remaining creatine goes to your heart, brain, and other tissues.
Most healthy people obtain sufficient amounts of creatine through diet, and supplements are usually not needed for general health. However, creatine supplements have become very popular among athletes, especially those involved in high-intensity workouts and sports.
Research has consistently shown that after supplementing creatine, exercise performance improves, particularly high-intensity activities.
Creatine is widely used among athletes, with the biggest benefit for people engaged in short-duration, high-intensity resistance activities. These include weight lifting, sprinting, and bicycling. Users get a quick burst of energy and increased strength, which in turn improves exercise performance and speeds up muscle recovery. Supplements may also help reduce muscle cramping as well as with healing injuries to the muscles, bones, ligaments, tendons, and nerves.
“Traditionally, [creatine has] been used in athletes, but more recently it’s been researched and used in women going through perimenopause and older adults to support sparing lean body mass,” says Maya Feller, RD, founder and lead dietitian at Maya Feller Nutrition in New York City.
She adds that creatine supplementation is “gaining traction” in the perimenopausal community because of the shifts in body composition that occur during the menopausal transition. “This results in the increased loss of lean muscle mass,” says Feller. “Supplementing with creatine may help to slow this loss down.”
Creatine is being explored for a wide range of uses, including cognition and brain health, age-related declines in skeletal muscle and bone mineral density, skin aging, neurodegenerative diseases, diabetes, osteoarthritis, and fibromyalgia.
Many of these conditions are experienced by women in perimenopause and menopause.
“During perimenopause, women experience hormonal shifts that can impact energy levels, bone health, and muscle mass,” says Bonnie Jortberg, PhD, RDN, an associate professor of family medicine at the University of Colorado School of Medicine. “Taking a creatine supplement may help to mitigate some of these symptoms and physiological changes.”
Research suggests that women may benefit from creatine supplements because they tend to have lower levels of creatine in their bodies compared with men. They have about 70 to 80 percent less naturally occurring creatine, and they consume significantly lower amounts in their diet.
Estrogen and progesterone levels also affect creatine levels. Creatine levels are lowest when estrogen is at its lowest, such as during the
follicular phase (beginning) of the menstrual cycle,
amenorrhea (absence of a menstrual cycle), and pregnancy. Levels of creatine are the lowest in postmenopausal women.
“Declining and loss of estrogen and progesterone can reduce creatine levels — which can increase the risk for muscle and bone loss — and mood changes,” says Mindy Goldman, MD, clinical professor emeritus and director of the Gynecology Program for Cancer Survivors and At-Risk Women at the University of California San Francisco. “There is emerging evidence that it might improve bone health, cognition, and mood. There is also some evidence that it may increase resting metabolic rate, which can improve insulin sensitivity, which helps with weight management and maintaining more muscle mass.”
Studies have examined the
benefits of creatine supplementation in both premenopausal and postmenopausal women, demonstrating that they can improve strength, exercise performance, bone density and muscle mass, and mood and cognition.
Research evaluating their use in the perimenopausal population has been extremely limited, although one small study recently explored the potential health benefits for women in both perimenopause and menopause. “The study is still undergoing peer review, but the findings are consistent with previous research showing that creatine supplementation coupled with resistance training can support cognitive function, bone health, and muscular health in aging populations,” says the study’s lead author, Lauren Hall, an undergraduate student at St. Olaf College in Minnesota (working under Jenny Miller, PhD, assistant professor of kinesiology). “What’s new — and exciting — is how these benefits extend specifically to perimenopausal women. This group often experiences fluctuating symptoms that aren’t always addressed in traditional menopause research.”
Of note, while both groups experienced improvements in sleep quality, the effect was more pronounced in perimenopausal women.
“This is particularly meaningful because sleep disturbances often begin during perimenopause and can cascade into other health issues,” says Hall. “We observed cognitive improvements in postmenopausal women, which aligns with creatine’s known role in brain energy metabolism. In perimenopausal women, the cognitive effects were more subtle but still promising.”
Hall and her team speculate that, given the hormonal variability during perimenopause, it’s possible that the benefits of creatine are more individualized or require longer-term supplementation to fully manifest.
There are dozens of brands and formulations of creatine to choose from. It can be a little daunting when trying to make a choice. Creatine supplementation should be done under the care of a qualified healthcare provider. Here are some things to consider before getting started:
- Formulation There are several different types of creatine that are commercially available. Creatine monohydrate has been the most extensively studied and is the most effective and affordable form, according to Dr. Jortberg.
- Type of Creatine Creatine is sold as a powder, in pills, as a liquid, and also as gummies and in energy bars. The powder is probably the most cost-effective form. It can be mixed with water, juice, or a protein shake and gives flexibility for dosing. But the bottom line is that it really is a matter of preference.
- Third-Party Testing While creatine supplements are generally considered safe, the supplement market is not fully regulated. “It is recommended that you purchase a creatine supplement that has either a National Sanitation Foundation or United States Pharmacopeia designation, as these companies certify supplements,” says Jortberg.
- Timing Research is inconclusive as to the best time to take creatine supplements, and it remains unclear if they should be taken before or after exercise. One study found it didn’t seem to make a difference, and the benefits were similar whether taken before or after a workout.
- Dose The recommendation is to take between 3 and 5 g of creatine supplement each day. “This dosage has been shown to be effective for increasing your creatine levels in muscle cells. A ‘more is better’ approach doesn’t work with creatine, as your body can only store so much. Taking more doesn’t mean your body will store more,” says Jortberg.
Creatine is a relatively safe supplement, but, as with any supplement, there can be side effects. These may include:
- Weight gain, usually due to water retention or increased muscle mass, not added body fat
- Dizziness
- Nausea and vomiting
- Gastrointestinal upset, including bloating, cramps, or diarrhea
- Excessive sweating
If you develop any of these side effects, they can be minimized by taking creatine in smaller doses that are spread out throughout the day. Speak with a healthcare professional for advice if you’re experiencing issues. They can help identify the best dose, timing, and type of creatine for you.
When Not to Take Creatine
Studies conducted decades ago had linked kidney problems to creatine supplements, but recent research has failed to find a connection. However, it remains unclear if it’s safe for people with preexisting kidney disease to take creatine supplements. “Creatine is processed in our kidneys, and, as such, those with known kidney disease or who are at risk of kidney disease should not take a creatine supplement,” says Jortberg. “Those who have been told to avoid high-protein diets should also not be using it.”
Because supplements are not fully regulated by the Food and Drug Administration (FDA), it’s important to speak with your doctor before starting any new supplements. Supplements have the potential to interact with other medications that you’re taking or affecting certain medical conditions.
The safety of creatine supplements has also not been studied enough in young children, pregnant women, and those who are breastfeeding.
People who are taking over-the-counter medications, prescription drugs, vitamins, and energy drinks should also speak with their healthcare provider before using creatine.
Rachel Green
Rachel Davis
Derek Schulz
Sophia Martinez
Dr. Amara Okafor