By: Yekta Dowlati, PhD

Introduction

Creatine is one of the most extensively studied dietary supplements, supporting its role in exercise performance, recovery, and clinical health. Despite this robust evidence base, discussions of creatine supplementation have historically centered on men, particularly athletes and bodybuilders.¹ This has left a significant gap in the clinical dialogue on women’s health—despite the fact that women possess 70–80% lower endogenous creatine stores compared to men, and often consume less through diet.¹

Emerging research now suggests that creatine offers unique advantages for women across the lifespan. From supporting exercise performance in premenopausal athletes to preserving bone, muscle, and cognitive function in post-menopausal women, creatine supplementation is an underutilized but clinically meaningful intervention.

Biochemistry and Mechanisms of Action

Creatine is synthesized endogenously from the amino acids arginine, glycine, and methionine and stored primarily in skeletal muscle as phosphocreatine (PCr).² During high-intensity activity, PCr rapidly donates a phosphate group to regenerate ATP, the body’s primary energy currency.² In women, creatine metabolism is influenced by sex hormones.¹ Estrogen and progesterone modulate creatine transport and the activity of creatine kinase, impacting both synthesis and utilization.¹ These fluctuations mean creatine requirements may vary across the menstrual cycle, during pregnancy, and in the postmenopausal years.¹ This hormone–creatine interplay highlights why supplementation may be especially important for female physiology.

Benefits for Performance and Musculoskeletal Health

Strength, Power, and Recovery

Numerous clinical trials confirm that creatine supplementation enhances muscular strength, power, and endurance in women, particularly during resistance training and sprint-based activities. Creatine improves muscle recovery by reducing markers of oxidative stress and inflammation, enabling women to train harder and recover more efficiently.¹ Crucially, creatine does not cause excessive bulk or fat gain, a frequent concern among female patients. Instead, it supports lean muscle accretion while minimizing fatigue.

Bone Integrity

Bone health is a key concern for women, especially in the context of menopause-related bone loss. Evidence shows that creatine:

• Enhances osteoblast differentiation and mineral deposition, supporting bone formation.³
• Reduces bone resorption activity, balancing remodeling.³
• When combined with resistance training, improves bone mineral density and strength in postmenopausal women.³

Research shows that creatine supplementation combined with exercise leads to key improvements in postmenopausal women, including improved bone mineral density and overall skeletal resilience.

Cognitive and Neurological Benefits

The brain is a high-energy-demand organ, with limited creatine storage capacity. Supplementation increases brain phosphocreatine, enhancing cellular energy buffering, neurotransmitter turnover, and oxidative defense. Clinical and pre-clinical studies indicate that supplementation may:¹

• Cognition: Supplementation has been shown to improve working memory, information processing, and mental fatigue resistance, particularly under sleep deprivation or psychological stress
• Mood and Depression: Preclinical and clinical studies indicate creatine may improve serotonergic and dopaminergic signaling, contributing to antidepressant effects. Women, who have higher rates of mood disorders during reproductive transitions, may particularly benefit
• Neuroprotection: Early evidence suggests a potential role in mitigating neurodegenerative processes, positioning creatine as a preventive strategy for age-related cognitive decline

Women Across the Lifespan

Reproductive Years

Creatine may optimize energy availability during the menstrual cycle and has been investigated in pregnancy for its potential to improve fetal and placental outcomes, particularly under conditions of hypoxia.¹ While human trials remain limited, animal and pilot studies highlight an exciting area of future research.

Perimenopause and Menopause

Declining estrogen levels contribute to sarcopenia, bone loss, and metabolic changes. Creatine supplementation has been shown to counteract these declines by improving muscle mass, strength, and metabolic efficiency. Higher dosing strategies (up to 0.3 g/kg/day) in combination with resistance training appear especially effective for post-menopausal women.¹

Aging and Longevity

Creatine may mitigate age-related frailty by enhancing muscle function, improving balance, and reducing fall risk. Its potential to improve glucose tolerance and reduce hepatic fat accumulation further supports its role in metabolic health among older women.¹

Safety and Clinical Guidance

Decades of research affirm that creatine monohydrate is safe and well tolerated at recommended doses. Standard protocols include:¹

• Loading phase: 20 g/day (divided into 4 doses) for 5–7 days (optional)
• Maintenance: 3–5 g/day or 0.1 g/kg/day

Long-term studies demonstrate no adverse effects on renal or hepatic function, hydration status, or hair health when used appropriately.

Conclusion

Creatine is not merely a supplement for athletes; it is a versatile, evidence-based intervention with relevance across women’s health. By addressing sex-specific gaps in endogenous creatine availability, supplementation supports muscle strength, bone density, cognitive function, and mood stability.

For healthcare professionals, creatine represents a safe, cost-effective, and underutilized strategy that can meaningfully enhance health outcomes in women throughout their lifespan. The time has come to move beyond outdated misconceptions and bring creatine to the forefront of women’s integrative and clinical care.

References

1. Smith-Ryan AE et al. Nutrients. 2021;13(3):877.
2. Kreider RB et al. Nutrients. 2021;13(2):447.
3. Candow DG et al. J Clin Med. 2019;8(4):488.

Yekta Dowlati, PhD, serves as the Medical Education Manager at Metagenics. Dr. Dowlati earned her PhD in Medical Sciences from the University of Toronto, along with her MSc in Pharmacology. Her academic credentials also include a BSc in nutrition. She furthered her expertise with a postdoctoral fellowship in Neuropsychopharmacology at the Centre for Addiction and Mental Health in Toronto. Dr. Dowlati’s research portfolio includes multiple clinical trials, and she has contributed to the scientific community through her authorship and co-authorship of articles in prestigious journals, alongside presenting her work at numerous national and international conferences. Before her tenure at Metagenics, she excelled as a senior medical writer and led medical writing teams, demonstrating her passion for learning and education to improve public health. Beyond her professional commitments, Dr. Dowlati cherishes family time, indulging in travel, fitness, and cooking, which speaks to her balanced approach to life.