Creatine and Women’s Health: What the Research Really Says

In this episode of the FemHealth Nutrition Podcast, we explore why this well-known supplement is gaining traction across women’s health. 

We’ll cover:

• The basics of creatine metabolism
• What the research says across different life stages
• Creatine’s potential benefits for strength, cognition, mood, and reproductive health
• Evidence-based dosing strategies and safety considerations

References 

• Chilibeck, P. D., et al. (2023). A 2-year RCT on creatine and bone health. Medicine & Science in Sports & Exercise, 55(10), 1750–1760.
  de Guingand, D. L., et al. (2024). Creatine metabolism in human pregnancy. The American Journal of Clinical Nutrition, 119(4), 838–849.
• Gordon, A. N., et al. (2023). Creatine and recovery in active women. Nutrients, 15(3567).
• Gualano, B., et al. (2008). Effects of creatine supplementation on muscle function and functional capacity in older women. European Journal of Applied Physiology, 102(2), 223–231.
• Gutiérrez-Hellín, J., et al. (2025). Creatine beyond athletics. Nutrients, 17(95).
  Muccini, A. M., et al. (2021). Creatine in female reproduction. Nutrients, 13(490).
• Ostojic, S. M., et al. (2024). Creatine intake and reproductive outcomes. Food Science & Nutrition, 12, 4893–4898.
• Ireland, Z., et al. (2020). Creatine supplementation during pregnancy improves neonatal survival after birth asphyxia in rats. Pediatric Research, 88(2), 254–260.
• Smith-Ryan, A. E., et al. (2021). Creatine across the female lifespan. Nutrients, 13(877).
• Buford, T. W., et al. (2007). International Society of Sports Nutrition position stand: Creatine supplementation and exercise. Journal of the International Society of Sports Nutrition, 4(1), 6.
• Dos Santos, L., et al. (2023). Effects of creatine supplementation in postmenopausal women: A systematic review and meta-analysis. Frontiers in Physiology, 14, 1165912.
• Cooper, R., Naclerio, F., Allgrove, J., & Jimenez, A. (2012). Creatine supplementation with specific view to exercise/sports performance: an update. Journal of the International Society of Sports Nutrition, 9(1), 33.
• Lyoo, I. K., Yoon, S., Kim, J. E., Hwang, J., Kim, T. S., Won, W., Bae, S., & Renshaw, P. F. (2012). A randomized, double‑blind placebo‑controlled trial of oral creatine monohydrate augmentation for enhanced response to a selective serotonin reuptake inhibitor in women with major depressive disorder. The American Journal of Psychiatry, 169(9), 937–945. https://doi.org/10.1176/appi.ajp.2012.12010009 cureus.com+9pubmed.ncbi.nlm.nih.gov+9link.springer.com+9
• Chilibeck, P. D., Kaviani, M., Candow, D. G., & Zello, G. A. (2017). Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: A meta-analysis. Open Access Journal of Sports Medicine, 8, 213–226

Transcript

 Hi, and welcome to the FemHealth Nutrition Podcast! I’m Nilou Deilami, a Registered       Dietitian and founder of the Women’s Health Nutrition Learning Hub—a platform where  dietitians and nutrition professionals can learn about all things  related to female health and nutrition. If you haven’t already, you can check out the  website at whnlearninghub.com. You can find many blog posts on women’s health related topics as well as free resources you can download. You can also join my newsletter where I send bi-weekly research updates on various topics as well as share new courses and learning opportunities. 

The link for the website in the episode descriptions. 

Also, if you have been listening to this podcast and feel like it gives you value, please feel subscribe, rate and share with others. With podcasts you don’t have that direct connection with your audience like with live sessions, so this would give me the signal to continue with this work. 

Now let’s get into the content for this episode. We’ll be talking about creatine and women’s health today. And as a reminder everything we cover here is intended as an educational podcast for dietitians, healthcare  professionals and anyone interested in female health and nutrition. The content covered  in this podcast is not intended as medical advice. If you have questions or concerns  about your health, please consult with your healthcare team. 

Now the reason I chose creatine supplementation for today’s topic is that I am seeing it being discussed everywhere- podcasts, instagram posts, LinkedIn. And from the content that is being shared creatine sounds like it’s this incredible multifunctional supplement that women have been missing out on. 

So we’ll do what we always do on this podcast- We’ll break down what creatine is, what its proposed physiological mechanisms are, the actual research in various female populations, safety considerations, and how dietitians and health professionals can responsibly apply this tool in practice.

Let’s begin with the basics. Creatine is a compound synthesized primarily in the liver and kidneys from the amino acids glycine, arginine, and methionine- this is what we will refer to as endogenous production. It can also be obtained through dietary sources—mainly red meat and seafood. For omnivores, about half of daily creatine needs come from food, the other half is synthesized endogenously.

Now to really understand how creatine works, we need to review some basic physiology first. 

ATP, or adenosine triphosphate, is the main energy currency of our cells. Just like money allows you to buy things in the real world, ATP “pays for” almost every biological process in the body—muscle contractions, nerve signaling, hormone production, even thinking.

But here’s the thing:

Cells don’t store a lot of ATP at any given time—just enough to last a few seconds during high-demand activity like sprinting, lifting, or rapid thinking. That’s where creatine steps in.

When the body uses ATP, it loses one phosphate group, turning it into ADP—adenosine diphosphate. Creatine, stored in muscles and other tissues as phosphocreatine (PCr), quickly donates its phosphate group to ADP, recycling it back into ATP. This happens in milliseconds and is especially critical when energy demand spikes.

About 95% of creatine is stored in skeletal muscle, where it fuels short bursts of movement and strength. The remaining 5% is in the brain, reproductive tissues, and other organs that need quick access to energy—especially important during cognitive strain, menstruation, or pregnancy (Smith-Ryan et al., 2021,Copper et al., 2012).

Why should we pay attention to creatine in women specifically? Several reasons:

• Women generally consume less creatine due to lower intake of red meat and seafood. 
  
  
  
• Endogenous creatine synthesis may be hormonally influenced, particularly by estrogen and progesterone.
  
  
  
• Females have smaller muscle mass and lower total creatine stores—estimated to be 70–80% of those in males (Smith-Ryan et al., 2021).
  
  
  
• Creatine’s effects may extend beyond muscle, potentially supporting cognition, mood, and metabolic regulation.
  
  
  

This is important for clinical dietitians working with a broad population of female clients—from adolescent athletes to perimenopausal adults to postmenopausal women with sarcopenia risk.

Over the last decade, creatine’s role has expanded from muscle-building into more diverse claims:

• Increased muscular strength and lean mass
  
  
  
• Improved cognitive performance and working memory
  
  
  
• Reduction in depressive symptoms, particularly in low-estrogen phases
  
  
  
• Enhanced recovery from exercise, especially in the luteal phase
  
  
  
• Protection against age-related muscle and bone loss
  
  
  
• Neuroprotection and reduced risk of perinatal brain injury (in animal models)
  
  
  

But how does the evidence stack up? Let’s walk through it by life stage.

Menstrual Cycle

The menstrual cycle modulates creatine metabolism and energy demands. Estrogen is known to stimulate creatine synthesis, while progesterone may suppress it.

Population-Level Data: Menstrual Irregularities and Reproductive Health

A 2024 NHANES analysis of 4,522 females found that 71.1% had suboptimal creatine intake (<13 mg/kg/day). Compared to those meeting that intake, those with lower dietary intake had:

• 25% higher odds of irregular periods (OR = 0.75)
  
  
  
• 42% higher odds of having had a hysterectomy (OR = 1.42)
  
  
  
• 26% higher odds of using hormone replacement therapy (OR = 1.26)
  
  
  

While this is observational, the findings suggest that creatine may be relevant for reproductive and hormonal health.

Researchers have also looked at the impact of creatine supplementation for active females. A 2023 randomized crossover study (Gordon et al.) tested creatine loading (20g/day for 5 days) across the cycle in active women. The key finding? In the luteal phase, creatine reduced sprint fatigue by 5.8%, compared to no change with placebo.

This suggests that creatine may help buffer against the fatigue and sluggishness many experience in the second half of the cycle

✅ Practice takeaway: For menstruating athletes or active clients, creatine may reduce fatigue and performance dips in the luteal phase. Consider cycle-aware strategies for dosing and education.

Pregnancy

Pregnancy is a metabolically demanding state. By the third trimester, energy requirements increase significantly to support fetal growth, maternal tissue expansion, and placental function. Creatine — a molecule that buffers ATP — may help support energy stability in both the maternal and fetal systems.

A 2024 cohort study by de Guingand et al. followed 282 low-risk pregnant individuals and found that while plasma creatine remained stable, urinary creatine excretion decreased significantly in late gestation — suggesting a conservation mechanism to meet rising physiological demands. Higher dietary creatine intake — primarily from meat and fish — was associated with improved maternal creatine status, though not directly linked to neonatal growth outcomes (de Guingand et al., 2024).

In animal studies, maternal creatine supplementation has been shown to:

• Protect fetal brain tissue during hypoxia (Muccini et al., 2021)
  
  
  
• Improve neonatal survival following birth asphyxia (Ireland et al., 2020)
  
  
  

Mechanistically, this is likely due to creatine’s ability to stabilize mitochondrial ATP production and reduce oxidative stress in low-oxygen environments.

⚠️ That said, there are no randomized controlled trials in humans evaluating creatine supplementation during pregnancy, and no official safety guidelines exist.  a food-first approach during gestation (Buford et al., 2007; Smith-Ryan et al., 2021).

✅ Practice takeaway: Creatine appears to be physiologically important in pregnancy — particularly for fetal brain protection and maternal energy metabolism. But until we have human RCTs, dietitians should focus on creatine-rich foods like red meat and fish, rather than supplements, during pregnancy.

Perimenopause

Perimenopause is seriously under-researched. Estrogen and progesterone both influence creatine metabolism (Muccini et al., 2021).

Theoretical benefits include support for mood, cognitive function, and muscle retention during fluctuating estrogen states, but RCTs are lacking.

Practice takeaway: For perimenopausal clients experiencing fatigue, muscle loss, or mood instability, creatine may offer adjunctive support—but we need more targeted trials.

Postmenopause

Postmenopause is characterized by a drop in estrogen that leads to accelerated loss of lean mass and bone mineral density. This presents an ideal opportunity to consider creatine as a supportive intervention.

Postmenopause is marked by declining estrogen levels, which contribute to the loss of muscle strength, lean mass, and bone integrity. Creatine supplementation—especially when paired with resistance training—has been explored as a potential strategy to help mitigate these effects.

In a meta-analysis of 22 studies with 721 adults aged 57–70, creatine supplementation during resistance training led to an average gain of 1.4 kg more lean muscle, a moderate boost in upper body strength, and a small but meaningful increase in lower body strength compared to placebo. About 32% of participants were women, and no serious side effects were reported (Chilibeck et al., 2017)..

A 2023 systematic review and meta-analysis by Dos Santos et al. examined 10 randomized controlled trials involving creatine and resistance training in postmenopausal women. According to the results:

• Upper-body strength improved significantly with creatine (SMD: 0.31, 95% CI: 0.02 to 0.60; p = 0.035).
  
  
  
• Lower-body strength also showed a significant effect (SMD: 0.27, 95% CI: 0.03 to 0.51; p = 0.027).
  
  
  
• Lean body mass showed a small effect size (SMD: 0.24, 95% CI: 0.03 to 0.45), but the authors concluded this was not statistically significant overall, and results were inconsistent.
  
  
  
• Functional capacity and bone mineral density did not significantly improve with creatine.

In shorter and longer-term trials, some improvements in muscle mass have been observed—but they are very modest.

For example, in a 12-week study in 60 participants by Gualano et al. (2008), women in the creatine group gained 1.03 kg of lean mass, compared to 0.22 kg in the placebo group (p = 0.05). Chair stand performance also improved only in the creatine group.

In a 2-year study by Chilibeck et al. (2023), lean tissue mass increased by 5.1% with creatine versus 3.5% with placebo (p = 0.042). Walking speed improved by 1.5 seconds over 80 meters, and bone geometry at the femoral neck (e.g., section modulus and buckling ratio) also improved—though bone mineral density itself did not change.

✅ Practice takeaway: For postmenopausal clients, creatine combined with resistance training can reliably improve muscle strength. And the effect on increasing lean muscle mass is quite small. 

Some studies report small gains in lean mass, but the improvements—when present—are modest. Functional outcomes like walking speed and bone structural strength may also benefit from longer-term use. Overall, creatine is best positioned as a supportive tool, not a primary treatment.

⚠️ Importantly, the evidence shows that creatine without resistance training does not consistently improve lean mass or strength in this population. 

Cognition & Mood

Creatine isn’t just for muscle—it plays a critical role in brain energy metabolism (Gutierrez-Hellin et al., 2025).

Theoretically, creatine may be helpful for women due to:

• 
  Lower baseline brain creatine levels compared to men
  
  
  
• Hormonal changes across the menstrual cycle, perimenopause, and menopause that may impact brain energy balance (Smith-Ryan et al., 2021; Muccini et al., 2021)
  
  
  
  

🧠 Cognitive Function

Narrative reviews suggest creatine may support reaction time and reduce mental fatigue in states of high cognitive demand, such as sleep deprivation. These effects are thought to be linked to creatine’s role in stabilizing cerebral ATP availability, though most of this data comes from small studies or theoretical models (Gutierrez-Hellin et al., 2025).

🙂 Mood

There is stronger evidence for creatine’s role in supporting mood:

• 
  In a randomized controlled trial of 52 adult women with major depressive disorder receiving SSRIs, those given 5 g/day of creatine monohydrate experienced a greater reduction in HAM-D scores by week 2 compared to placebo (−11.9 vs. −6.4; p = 0.047), with sustained improvement through 8 weeks (Lyoo et al., 2012).
  
  
  
• A 2024 NHANES analysis of 4,522 adult females found that those in the lowest quartile of creatine intake had 31% higher odds of depression compared to those with higher intake levels (Ostojic et al., 2024).
  
  
  
  

✅ Practice takeaway: Creatine may offer measurable benefits for mood regulation in women, especially in low-estrogen states or for those already on antidepressant therapy. Typical supplemental doses range from 3–5 g/day of creatine monohydrate.

Risks and Safety

Creatine is one of the most studied dietary supplements worldwide. It has a strong safety profile when used appropriately.

• Kidney Function: No adverse effects in healthy individuals up to 2 years. However, avoid use in those with known kidney disease.
  
  
  
• GI Issues: Some users may experience bloating or cramping with large single doses.
  
  
  
• Pregnancy: Lack of human safety data—use food-first approaches during this time.
  
  
  

The International Society of Sports Nutrition (2021) considers creatine monohydrate “safe, effective, and ethical” for use in healthy populations.

Dosing & Implementation

Dosing:

Creatine Monohydrate – most evidence-backed, cost-effective, and stable.

• Loading Phase (Optional): 20 g/day split into 4 doses for 5–7 days
  
  
  
• Maintenance Phase: 3–5 g/day ongoing
  
  
  
• Alternative: 0.1 g/kg/day (more precise for smaller clients)
  
  
  

When to Recommend:

• Benefits are small so you don’t have to recommend them:
• Peri or postmenopause who are actively doing resistance training (this is for bone and muscle health)
• Athletes with menstrual phase-related fatigue
• Vegan or vegetarian clients (with very low creatine intake)
• Female clients reporting mood/cognitive fluctuations

Final Thoughts for Dietitians

The research on the benefits of creatine is far from definitive. But as far as supplements go, creatine has a good safety profile and so if someone really wants to add into their regimen, then that’s okay. I think we just need to manage expectations as creatine the effects will likely be small and other lifestyle measures like general healthy eating, exercise and stress management are still important

As dietitians, we can:

• Evaluate dietary creatine intake as part of nutritional assessment
• Offer evidence-based counseling on supplementation timing and dosing
• Advocate for more inclusive and female-centered research.

References (APA Style)

• Chilibeck, P. D., et al. (2023). A 2-year RCT on creatine and bone health. Medicine & Science in Sports & Exercise, 55(10), 1750–1760.
  de Guingand, D. L., et al. (2024). Creatine metabolism in human pregnancy. The American Journal of Clinical Nutrition, 119(4), 838–849.
• Gordon, A. N., et al. (2023). Creatine and recovery in active women. Nutrients, 15(3567).
• Gualano, B., et al. (2008). Effects of creatine supplementation on muscle function and functional capacity in older women. European Journal of Applied Physiology, 102(2), 223–231.
• Gutiérrez-Hellín, J., et al. (2025). Creatine beyond athletics. Nutrients, 17(95).
  Muccini, A. M., et al. (2021). Creatine in female reproduction. Nutrients, 13(490).
• Ostojic, S. M., et al. (2024). Creatine intake and reproductive outcomes. Food Science & Nutrition, 12, 4893–4898.
• Ireland, Z., et al. (2020). Creatine supplementation during pregnancy improves neonatal survival after birth asphyxia in rats. Pediatric Research, 88(2), 254–260.
• Smith-Ryan, A. E., et al. (2021). Creatine across the female lifespan. Nutrients, 13(877).
• Buford, T. W., et al. (2007). International Society of Sports Nutrition position stand: Creatine supplementation and exercise. Journal of the International Society of Sports Nutrition, 4(1), 6.
• Dos Santos, L., et al. (2023). Effects of creatine supplementation in postmenopausal women: A systematic review and meta-analysis. Frontiers in Physiology, 14, 1165912.
• Cooper, R., Naclerio, F., Allgrove, J., & Jimenez, A. (2012). Creatine supplementation with specific view to exercise/sports performance: an update. Journal of the International Society of Sports Nutrition, 9(1), 33.
• Lyoo, I. K., Yoon, S., Kim, J. E., Hwang, J., Kim, T. S., Won, W., Bae, S., & Renshaw, P. F. (2012). A randomized, double‑blind placebo‑controlled trial of oral creatine monohydrate augmentation for enhanced response to a selective serotonin reuptake inhibitor in women with major depressive disorder. The American Journal of Psychiatry, 169(9), 937–945. https://doi.org/10.1176/appi.ajp.2012.12010009 cureus.com+9pubmed.ncbi.nlm.nih.gov+9link.springer.com+9
• Chilibeck, P. D., Kaviani, M., Candow, D. G., & Zello, G. A. (2017). Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: A meta-analysis. Open Access Journal of Sports Medicine, 8, 213–226