Creatine and Perimenopause: What You Need to Know

“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.”

“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.”

“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.”

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.”

“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.”

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.

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• Dose The recommendation is to take between 3 and 5 g of creatine supplement each day.

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   “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.

• 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.”

• Supplementing with creatine may help perimenopausal women improve muscle strength, sleep quality, cognition and mood, and bone health.
• Creatine supplements have been extensively researched and are considered safe for healthy individuals when used at recommended doses.
• More research is needed to evaluate the effect and benefits in the perimenopausal population.
• Select a high-quality product, use it at the proper dose, and consult a healthcare provider before using, especially if you have kidney problems or other medical conditions.