The cognitive and physical benefits women need to know about in midlife
4 minute read
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- Why do women have lower creatine levels than men?
- Can creatine help with muscle loss in perimenopause?
- What does creatine do for brain health and cognition?
- Can creatine support energy and mood during perimenopause?
- Does creatine support bone health?
- What is the connection between creatine and healthy ageing?
- What dose and form of creatine should women take?
- Is creatine safe for women?
Creatine has spent decades being associated almost exclusively with men lifting weights. That association is now changing, and the research behind the change is worth paying close attention to — particularly for women in perimenopause.
Here is what the evidence actually shows.
Why do women have lower creatine levels than men?
Women have approximately 70 to 80% lower endogenous creatine stores than men, and consume significantly less dietary creatine because it is found primarily in red meat, poultry, and fish.¹ Women following plant-rich or plant-exclusive diets have even lower baseline levels.
During perimenopause, this gap widens. The decline in oestrogen that characterises this transition affects creatine metabolism directly. Sex hormones — particularly oestrogen — influence how efficiently the body makes and stores creatine.² At a time when the body is already producing less creatine, its ability to synthesise and retain it is further compromised by hormonal change.
The result is that perimenopausal women are often running low on a compound that is critical for cellular energy production, muscle maintenance, brain function, and bone health — and most are not replacing it.
Can creatine help with muscle loss in perimenopause?
Women begin losing muscle mass at a rate of approximately 0.5 to 1% per year from their 30s onwards, with this loss accelerating significantly after menopause as oestrogen declines. Without intervention, women can lose up to 30% of their muscle mass between the ages of 50 and 80 — a condition known as sarcopenia, with significant implications for metabolic health, mobility, and independence.
Creatine supplementation combined with resistance training has been shown in clinical trials to meaningfully support this process. A meta-analysis of randomised controlled trials in older adults found that creatine supplementation alongside a resistance training programme produced significantly greater improvements in lean tissue mass, muscle strength, and physical function compared to resistance training plus placebo.³ The benefit of creatine appears to be additive to exercise rather than substitutive for it — in other words, it works best when you move, and it makes that movement work harder for you.
What does creatine do for brain health and cognition?
One of the most compelling emerging areas of creatine research for women in midlife is its effects on cognition. The brain accounts for approximately 20% of total energy expenditure at rest despite comprising only 2% of body mass. It requires a continuous supply of energy, and creatine plays a central role in keeping that supply going.
An 8-week randomised controlled trial specifically in perimenopausal and menopausal women — the CONCRET-MENOPA trial — found that creatine supplementation improved reaction time, increased brain creatine levels, and produced favourable improvements in cholesterol markers compared to placebo.⁴
A broader systematic review of creatine supplementation and cognitive function found consistent support for short-term memory and reasoning ability, with effects most pronounced in groups under metabolic or physiological stress — a category that very much includes women navigating the hormonal shifts of perimenopause.⁵
Can creatine support energy and mood during perimenopause?
Fatigue and low mood are among the most commonly reported — and least openly discussed — symptoms of perimenopause. Both have a significant neurobiological component, and both appear to be influenced by how well the brain can generate and use energy.
When the brain's energy production becomes less efficient — something that can happen as oestrogen declines — the downstream effects on mood, motivation, and mental clarity are real and measurable.⁶ Creatine helps to replenish the brain's energy reserves, and there is a growing body of evidence to suggest this has meaningful effects on mood as well as cognition.
Clinical evidence for creatine's effects on mood is still developing but is increasingly compelling. A 2025 systematic review and meta-analysis of eleven randomised controlled trials found that creatine supplementation was associated with a meaningful reduction in depressive symptoms compared to placebo — with women appearing to respond particularly well.⁷ A separate pilot double-blind RCT found that adding creatine monohydrate to standard psychological therapy significantly improved depressive symptoms, with the creatine group showing substantially greater reductions in depression scores by week four compared to placebo.⁸
It is worth being clear that this research is in its early stages for perimenopause specifically, and creatine should not be seen as a treatment for clinical depression. However, for women experiencing the low mood, mental fatigue, and reduced motivation that are so common in this life stage, the emerging evidence for creatine as a brain energy support is worth taking seriously.
Does creatine support bone health?
The decline in bone density that accelerates after menopause is one of the most significant health concerns facing women in midlife. The role of creatine in supporting bone health is less well known than its muscular effects, but the evidence is encouraging.
A 2-year randomised controlled trial in postmenopausal women found that those supplementing with creatine alongside regular exercise maintained stronger bone structure at the hip compared to those on placebo — including improvements in how the bone is built that are associated with reduced fracture risk.⁹ The mechanism appears to involve creatine supporting the energy needs of the cells responsible for building new bone. Whilst effects on bone density measurements alone were modest in this trial, the structural improvements are clinically meaningful for long-term bone resilience.
What is the connection between creatine and healthy ageing?
This is an area that is generating real excitement in the research community, and with good reason. Creatine is not simply a performance supplement — it is a compound with fundamental roles in cellular energy efficiency, protecting the mitochondria, and maintaining the tissue that declines most with age.
A 2025 narrative review in the Journal of the International Society of Sports Nutrition described the creatine system as providing wide-ranging protective effects against the metabolic and cellular stress that accumulates across a lifetime — and positioned it as likely contributing to healthy ageing, resilience, and longevity.¹⁰ Creatine has been shown to help protect the body's energy-producing machinery in muscle, heart, and brain tissue simultaneously.
Emerging research has also begun to explore links between declining creatine levels and how we age at a cellular level. A 2025 study found that the body's own creatine production progressively falls with age — most steeply in those over 65 — and that this decline may intersect with the biological markers that predict mortality risk.¹¹ This research is very new and requires further replication before firm conclusions can be drawn, but it adds a compelling dimension to the case for creatine as a long-term nutritional strategy rather than a short-term supplement.
What is already well established is that the conditions creatine most directly addresses — muscle loss, cognitive decline, low bone strength, reduced cellular energy — are among the primary drivers of reduced quality of life and independence in later years. Addressing them during perimenopause, when the trajectory is still highly modifiable, is arguably the most important window in which to act.
What dose and form of creatine should women take?
Is creatine safe for women?
Creatine is one of the most researched supplements in nutritional science and has a well-established safety record. A comprehensive position statement from the International Society of Sports Nutrition found no evidence of harmful effects on kidney or liver function in healthy individuals at typical doses.¹³ Women with pre-existing kidney conditions should speak to their GP before supplementing.
The picture that emerges from the research is of a compound that has been significantly under-utilised by women — particularly during the life stage when the evidence for its benefits is strongest.
Alice Mackintosh BSc (Hons), mBANT, CNHC
Co-Founder and Registered Nutritional Therapist, Equi London
Equi's Creatine Edition contains pure creatine monohydrate — the form with the strongest clinical evidence — at an effective daily dose.
Shop Creatine Edition HERE
References
1. Smith-Ryan AE, Cabre HE, Eckerson JM, Candow DG. Creatine supplementation in women's health: a lifespan perspective. Nutrients. 2021;13(3):877.
2. Ellery SJ, Walker DW, Dickinson H. Creatine for women: a review of the relationship between creatine and the reproductive cycle and female-specific benefits of creatine therapy. Amino Acids. 2016;48(8):1807–1817.
3. Chilibeck PD, Kaviani M, Candow DG, Zello GA. Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: a meta-analysis. Open Access J Sports Med. 2017;8:213–226.
4. Korovljev D, Ostojic J, Panic J, Ruzic M, Todorovic N, Ostojic SM. The effects of 8-week creatine hydrochloride and creatine ethyl ester supplementation on cognition, clinical outcomes, and brain creatine levels in perimenopausal and menopausal women (CONCRET-MENOPA): a randomized controlled trial. J Am Nutr Assoc. 2025;45(3):199–210.
5. Avgerinos KI, Spyrou N, Bougioukas KI, Kapogiannis D. Effects of creatine supplementation on cognitive function of healthy individuals: a systematic review of randomized controlled trials. Exp Gerontol. 2018;108:166–173.
6. Roschel H, Gualano B, Ostojic SM, Rawson ES. Creatine supplementation and brain health. Nutrients. 2021;13(2):586.
7. Shaikh MF, Lin YH, Huang P, et al. Creatine supplementation for treating symptoms of depression: a systematic review and meta-analysis. Br J Nutr. 2025. [Citation to be confirmed on publication]
8. Sherpa NN, De Giorgi R, Ostinelli EG, et al. Efficacy and safety profile of oral creatine monohydrate in add-on to cognitive-behavioural therapy in depression: an 8-week pilot, double-blind, randomised, placebo-controlled feasibility and exploratory trial in an under-resourced area. Eur Neuropsychopharmacol. 2025;90:28–35.
9. Chilibeck PD, Candow DG, Gordon J, et al. A 2-yr randomized controlled trial on creatine supplementation during exercise for postmenopausal bone health. Med Sci Sports Exerc. 2023;55(10):1750–1760.
10. Candow DG, Ostojic SM, Chilibeck PD, et al. Creatine monohydrate supplementation for older adults and clinical populations. J Int Soc Sports Nutr. 2025;22(Suppl 1):2534130.
11. Ostojic SM, Kavecan I. Linking dietary creatine to DNA methylation-based predictors of mortality in individuals aged 50 and above. Lifestyle Genomics. 2025;18(1):131–136. doi:10.1159/000547260.
12. Jager R, Purpura M, Shao A, Inoue T, Kreider RB. Analysis of the efficacy, safety, and regulatory status of novel forms of creatine. Amino Acids. 2011;40(5):1369–1383.
13. Kreider RB, Kalman DS, Antonio J, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017;14:18.
Disclaimer: This article is for educational purposes only and does not constitute medical advice. Food supplements should not be used as a substitute for a varied, balanced diet or healthy lifestyle. Creatine Edition is not suitable during pregnancy or breastfeeding. If under medical supervision, consult a healthcare professional before use.
