How Can Creatine Benefit Active Women During Perimenopause?

When most people hear “creatine,” they think of bodybuilders, gym enthusiasts or protein shakes. But this small amino acid compound may hold significant benefits for women in perimenopause, a stage marked by hormonal shifts that affect strength, energy, metabolism and mood.

Perimenopause, the several years leading up to menopause, typically begins in a woman’s 40s but can start earlier. During this time, estrogen and progesterone levels fluctuate unpredictably. These hormonal changes can contribute to fatigue, decreased muscle mass, changes in body composition, brain fog and slower recovery after exercise. 

While lifestyle factors such as nutrition, exercise and sleep remain essential, research suggests that creatine may offer targeted support for women navigating this transition.

What is creatine?

Creatine is a naturally occurring compound made from three amino acids: arginine, glycine and methionine. It is produced in the liver and stored mainly in skeletal muscle as phosphocreatine, where it serves as a rapid energy reserve. When your body needs quick bursts of power, such as climbing stairs, sprinting or lifting weights, phosphocreatine helps regenerate adenosine triphosphate (ATP), your body’s immediate source of energy.

Although your body produces some creatine naturally, most people also get it from foods such as red meat and fish. However, even with a balanced diet, many women have lower baseline creatine stores than men, and these levels tend to decline further with age and reduced estrogen. This makes supplementation particularly useful during perimenopause, when maintaining energy and muscle tone becomes more challenging.

How does creatine support brain function and mood?

Emerging research shows that creatine may help support brain energy metabolism and cognitive function, particularly during periods of hormonal fluctuation. Estrogen plays a key role in maintaining brain energy efficiency and neurotransmitter balance. When estrogen levels drop, so can mitochondrial activity, which is the process by which the brain produces energy.

Creatine helps bridge this gap by enhancing the brain’s ability to generate adenosine triphosphate. This may improve focus, reduce mental fatigue and stabilize mood. Some studies have explored creatine as a supportive tool for mood disorders such as depression, particularly in women, because of its influence on serotonin balance and how the brain makes and uses energy.

In a recent study, researchers found that creatine supplementation improved working memory and mental processing speed, especially in people under physical or emotional stress. This finding is particularly relevant to perimenopausal women, who may experience both increased stress sensitivity and cognitive fog.

Creatine may not be a brain booster in the traditional sense, but it supports the cellular energy your brain needs to perform at its best. It may help you stay focused and resilient when hormones fluctuate.

How does creatine help to maintain muscle strength and lean mass?

Muscle preservation becomes more difficult during perimenopause, largely because estrogen supports muscle protein synthesis. As estrogen levels drop, women may notice reduced muscle tone, slower recovery from workouts and an increased tendency toward fat gain, particularly around the midsection.

Supplementing with creatine, typically 3 to 5 grams per day adjusted for body weight, can help counteract this decline. Studies have shown that women who combine creatine with resistance training experience measurable increases in strength, endurance and lean muscle mass compared with training alone.

For women under about 130 pounds, a slightly lower daily dose of 2 to 3 grams may be more appropriate.

Even if you are not lifting heavy weights, creatine can make daily activities such as carrying groceries, climbing stairs or brisk walking feel easier and less fatiguing.

How does creatine support bone health? 

Bone density naturally decreases with age and declining estrogen, raising the risk of osteoporosis. While creatine alone has not consistently improved bone density in clinical trials, its indirect effect through muscle strengthening is promising. Stronger muscles exert greater, healthier forces on bones, a relationship known as the muscle-bone unit.

For women in perimenopause, this means creatine can act as a supportive partner in a comprehensive approach to skeletal health. It is not a replacement for weight-bearing exercise, but an amplifier of its benefits.

How do I use creatine safely? 

Creatine is one of the most researched and well-tolerated supplements available, but how you use it matters.

• Take it on active days. Use creatine on days when you engage in resistance training, sprinting or high-intensity workouts.
• Be consistent. Muscles benefit most when creatine is taken regularly alongside an active training routine.
• Choose a high-quality product. Look for a third-party tested creatine monohydrate supplement. This is the most studied and reliable form available.
• Hydrate well. Creatine draws water into muscle cells, which helps with energy production but requires adequate hydration to avoid cramping or discomfort.
• Check baseline kidney function. Research shows long-term use is safe for people with normal kidney health, but it is wise to confirm this with your physician before starting supplementation.

How and when should women take creatine during perimenopause? 

Timing is not critical; consistency is what matters most. Some people take creatine before workouts for a perceived energy boost, while others take it afterward to support recovery. Taking it with a meal that includes carbohydrates or protein may enhance absorption.

Because creatine may cause temporary water retention inside muscle cells, you might notice a slight increase on the scale in the first few days. This is not fat gain. It is a normal part of the muscle’s hydration and energy storage process.

Are there any negatives to taking creatine as a woman?

Creatine is safe and well-researched, but some mild side effects can occur when starting out. Temporary water retention may happen as muscles draw in water. Some women may also experience mild digestive discomfort, such as cramping or nausea, if taking too much at once or on an empty stomach.

These effects are typically short-lived and can be prevented by staying hydrated, splitting doses throughout the day and using a high-quality product.

What does creatine do to female hormones?

Creatine doesn’t directly change hormone levels such as estrogen or progesterone. Women generally have lower natural creatine stores than men, and these levels may vary slightly throughout the menstrual cycle, pregnancy or menopause.

Should I talk with my doctor about using creatine before I begin?

Always discuss any supplement use with your physician, especially if you take prescription medications or have kidney, liver or heart conditions. Your doctor can help determine whether creatine fits safely into your wellness plan and whether any blood work, such as kidney function testing, is recommended before starting.

What role does creatine play in perimenopausal strength?

Creatine works best when it complements other healthy habits. Regular resistance training, such as lifting weights or bodyweight exercises, is the most powerful way to build and maintain muscle and bone strength. Pair that with a balanced diet rich in protein, complex carbohydrates and omega-3 fats, and you will create an environment that allows creatine to work most effectively.

Adequate sleep, ideally seven to nine hours per night, and consistent stress management through movement, mindfulness or relaxation techniques will also improve recovery, hormone balance and mental clarity during perimenopause.
Creatine is not a magic bullet, but it can be an effective ally in this broader approach to well-being.

The bottom line

Perimenopause is a time of major metabolic change, but it also presents an opportunity to build long-term health habits that support your body through the decades ahead. When combined with resistance training, hydration and a nutrient-rich diet, creatine may be a simple, science-backed way to enhance strength, cognition and resilience during this transition.

For many women, a small daily scoop of creatine monohydrate can mean greater energy, sharper focus and stronger muscles. It can help you move, think and live with confidence through perimenopause and beyond.

Learn more about Tyler Perrin-Bellelo, MD, FACP, D-ABOM.