Creatine for female health: Don’t fall into the trap of thinking it’s just for elite athletes

For decades, creatine has been somewhat viewed only as an athletic supplement, mostly associated with male bodybuilders. This perception has led to a major oversight of the potential of creatine to support a much broader population over a lifetime, across the spectrum of high-performance and longevity, and both sexes. Read on for the detail but the benefits extend across the well-known strength and muscle function, through to bone health, brain function, mood and mitigation of sleep deprivation.

It is not just perceptions of who might benefit from creatine but, like many areas of healthcare, a sex bias in academic publications also exists. This gap is starting to close, highlighting the data on creatine's benefits for women, particularly across significant hormonal life stages. For all of us, two of the major threats to long-term health and performance are the age-related decline in muscle and bone health, and the decline in both cognition and mood. 

For individuals who follow a vegetarian or vegan diet, the body must produce almost all of the creatine it needs from scratch, a process known as de novo synthesis. Studies suggest that this internal production might not always be enough, as people who consistently eat vegetarian diets often have lower levels of creatine in their blood and muscles. This is likely because the creatine naturally found in meat and fish is missing from their diet. For those on a typical US diet, women synthesise 70% to 80% less than men [PMID: 17430086]. Given that women naturally have lower endogenous creatine stores than men, supplementation may yield even more pronounced, essential benefits.

What is creatine?

Creatine is an organic substance made up from three amino acids (the fundamental building blocks that make up proteins) derivative naturally produced in the liver and kidneys that plays a crucial role in providing rapid energy to cells, primarily muscle and brain cells, by regenerating adenosine triphosphate (ATP), the molecule used by cells to fuel almost all their activities. 

Because its metabolism is influenced by hormonal fluctuations, particularly oestrogen, women's needs and responses to creatine differ from men's. The synthesis and transport of creatine are altered throughout the menstrual cycle, during pregnancy, and in the post-menopausal years, making tailored supplementation an interesting strategy [PMID: 33800439].

Figure 1: Creatine metabolism varies throughout the menstrual cycle. Source: Apdapted from Smith-Ryan et al 2021. [PMID: 33800439]

For many women, the peri-menopausal state brings significant changes, often at a key point in their life and careers. The menopausal transition, characterised by a sharp decline in oestrogen, marks a profound shift for women when their health needs and risks can change a lot. This hormonal shift accelerates the loss of muscle mass (sarcopenia) and bone mineral density (osteoporosis), directly threatening long-term independence and quality of life. Creatine offers potential mitigation to these risks.

Buffering stress: brain fuel for stress, mood and cognitive optimisation

One of the emerging understandings of recent research is the potential benefit in terms of long-term cognitive health. The brain is a high energy-demand organ, requiring substantial ATP to function, particularly during complex cognitive tasks, sleep deprivation, or periods of intense stress, often an everyday reality for many! Given the sex differences in how much creatine is typically found in the brain, supplementation could prove especially effective for women in increasing energy and promoting better brain function and mood. 

Depression is more prevalent in women, up to two-fold higher and linked to key hormonal stages across the lifespan [PMID: 12745313]. Interestingly, the severity of a depressive episode has been inversely linked to the concentration of creatine in the brain [PMID: 15123489]. Indeed, when this link was tested in a double-blind randomised, controlled trial in women with major depression, adding 5 g/day of creatine to an antidepressant (the group called SSRIs), it led to faster and greater symptom improvement than the antidepressant alone [PMID: 22864465]. Similarly, on a proactive approach, dietary creatine intake has been found to be inversely related to the rates of depression occurrence, with a 31% greater incidence in those in the lowest quartile of ingestion of creatine [PMID: 32066709]. 

Cognitive function is a commonly discussed symptom of hormonal changes. A recent systematic review and meta-analysis (an academic review of multiple papers on a subject) specifically examined creatine's effects on adult cognition [PMID: 39070254]. The paper confirmed that creatine supplementation yielded measurable cognitive benefits, specifically on memory and processing speed in adults, and more interesting was that in the subgroup analysis, the cognitive benefits were more pronounced in females compared to males.

Stress and sleep deprivation are key factors that influence both mood and cognitive function. Recent research has contributed to the evidence base now suggesting that regular supplementation with creatine can be particularly beneficial in sleep deprivation and highlighted that even a single dose of creatine can have measurable positive effects to improve cognitive performance [PMID: 38418482]. Studies suggest that when women are sleep-deprived, they may experience poorer thinking ability and lower sleep quality specifically during the follicular phase of their menstrual cycle (when estrogen levels are low). This is also the time when the enzyme creatine kinase appears to be at its lowest concentration [PMID: 29790961].

The strongest use case here is not necessarily enhancing a rested brain, but increasing resilience during stress or fatigue. Creatine functions as a cognitive buffer, enhancing the brain's energy capacity when it is challenged by demanding mental tasks, high cognitive load, hormonal fluctuations or lack of sleep. All common realities in everyday life.

Building resilience: strength, lean mass and bone health preservation

Creatine supplementation is most well-known for its benefits on muscle function. For strength performance, creatine demonstrates a consistent improvement in performance compared to placebo, and similarly, improvements have been found in studies looking at both anaerobic and aerobic exercise performance [PMID: 33800439]. One of the concerns that is often cited for hesitance is the concern of weight gain, however, this hasn’t been demonstrated to be the case [PMID: 32549301].

In the post-menopausal state, one of the core benefits of creatine in women is its ability to potentiate the effect of resistance training. In this phase of life, maintaining muscle mass is a key component of metabolic health and functional longevity ie still being able to be active with family into the twilight years. The drop in estrogen that occurs during menopause is a primary reason for the age-related loss of muscle mass, bone density, and overall strength in women.

Studies have shown that in older women, resistance training in combination with creatine increases lean mass [PMID: 24530883; PMID: 23053133], strength [PMID: 24530883; PMID: 23053133], reduces bone density loss at the hip [PMID: 25386713].

Key takeaways

Creatine is not just for elite performance. It should be a foundational component of a holistic health plan and, as the evidence gap closes, it seems particularly for women. It is best served in combination with a resistance training programme to amplify the benefits. 

Frequently Asked Questions

Q: Will creatine cause undesirable weight gain in women?

A: Creatine works by drawing water into the muscle cells, which can result in a minor increase in body weight, typically less than a kilogram. This is intracellular water gain, not fat gain. Many early concerns about weight gain are unfounded, particularly in women, and the benefits for body composition (increasing lean mass) far outweigh this minor, non-fat-based change.

Q: Is creatine safe to take long-term?

A: Yes. Creatine monohydrate is one of the most thoroughly researched supplements, with a favourable safety profile for long-term use in healthy adults. It does not negatively impact kidney or liver function in healthy individuals.

Q: Should women on hormonal contraceptives take creatine?

A: Research is still exploring the interplay between hormonal contraception and creatine kinetics. However, given the broad-based benefits on muscle, bone, and cognition, and its strong safety profile, there is no evidence to suggest women on contraceptives should avoid it. It remains a low-risk, high-potential strategy for most.

Q: Does creatine affect cholesterol or other markers of metabolic health?

A: Emerging research suggests potential metabolic benefits. Creatine supplementation may help to improve markers like cholesterol and triglycerides in those with elevated levels. By promoting lean mass preservation, it also indirectly supports better insulin sensitivity and blood sugar regulation.

Q: Is there any risk of hair loss or side effects like acne from creatine?

A: While one isolated, non-replicated study in young male athletes reported an increase in the androgen dihydrotestosterone (DHT), this finding has not been reproduced in subsequent, robust trials across various populations, including women. Current clinical consensus maintains that creatine monohydrate does not cause or accelerate hair loss, acne, or other unwanted androgenic side effects in the general population.

Q: When is the best time to take creatine?

A: Timing matters less than consistency. Co-ingestion with carbohydrate and protein can aid uptake, but daily adherence is the main driver of benefit.

Further Reading

Aguiar AF, Januário RS, Junior RP, Gerage AM, Pina FL, do Nascimento MA, Padovani CR, Cyrino ES. Long-term creatine supplementation improves muscular performance during resistance training in older women. Eur J Appl Physiol. 2013 Apr;113(4):987-96. doi: 10.1007/s00421-012-2514-6. Epub 2012 Oct 7. PMID: 23053133.

Bakian AV, Huber RS, Scholl L, Renshaw PF, Kondo D. Dietary creatine intake and depression risk among U.S. adults. Transl Psychiatry. 2020 Feb 3;10(1):52. doi: 10.1038/s41398-020-0741-x. PMID: 32066709

Bebbington P, Dunn G, Jenkins R, Lewis G, Brugha T, Farrell M, Meltzer H. The influence of age and sex on the prevalence of depressive conditions: report from the National Survey of Psychiatric Morbidity. Int Rev Psychiatry. 2003 Feb-May;15(1-2):74-83. doi: 10.1080/0954026021000045976. PMID: 12745313.

Brosnan JT, Brosnan ME. Creatine: endogenous metabolite, dietary, and therapeutic supplement. Annu Rev Nutr. 2007;27:241-61. doi: 10.1146/annurev.nutr.27.061406.093621. PMID: 17430086.

Chilibeck PD, Candow DG, Landeryou T, Kaviani M, Paus-Jenssen L. Effects of Creatine and Resistance Training on Bone Health in Postmenopausal Women. Med Sci Sports Exerc. 2015 Aug;47(8):1587-95. doi: 10.1249/MSS.0000000000000571. PMID: 25386713.

Chilibeck PD, Candow DG, Gordon JJ, Duff WRD, Mason R, Shaw K, Taylor-Gjevre R, Nair B, Zello GA. A 2-yr Randomized Controlled Trial on Creatine Supplementation during Exercise for Postmenopausal Bone Health. Med Sci Sports Exerc. 2023 Oct 1;55(10):1750-1760. doi: 10.1249/MSS.0000000000003202. Epub 2023 May 5. PMID: 37144634

Dager SR, Friedman SD, Parow A, Demopulos C, Stoll AL, Lyoo IK, Dunner DL, Renshaw PF. Brain metabolic alterations in medication-free patients with bipolar disorder. Arch Gen Psychiatry. 2004 May;61(5):450-8. doi: 10.1001/archpsyc.61.5.450. PMID: 15123489.

de Guingand DL, Palmer KR, Snow RJ, Davies-Tuck ML, Ellery SJ. Risk of Adverse Outcomes in Females Taking Oral Creatine Monohydrate: A Systematic Review and Meta-Analysis. Nutrients. 2020 Jun 15;12(6):1780. doi: 10.3390/nu12061780. PMID: 32549301;

Gordji-Nejad A, Matusch A, Kleedörfer S, Jayeshkumar Patel H, Drzezga A, Elmenhorst D, Binkofski F, Bauer A. Single dose creatine improves cognitive performance and induces changes in cerebral high energy phosphates during sleep deprivation. Sci Rep. 2024 Feb 28;14(1):4937. doi: 10.1038/s41598-024-54249-9. PMID: 38418482.

Gualano B, Macedo AR, Alves CR, Roschel H, Benatti FB, Takayama L, de Sá Pinto AL, Lima FR, Pereira RM. Creatine supplementation and resistance training in vulnerable older women: a randomized double-blind placebo-controlled clinical trial. Exp Gerontol. 2014 May;53:7-15. doi: 10.1016/j.exger.2014.02.003. Epub 2014 Feb 13. PMID: 24530883.

Lyoo IK, Yoon S, Kim TS, Hwang J, Kim JE, Won W, Bae S, Renshaw PF. 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. Am J Psychiatry. 2012 Sep;169(9):937-945. doi: 10.1176/appi.ajp.2012.12010009. PMID: 22864465

Smith-Ryan AE, Cabre HE, Eckerson JM, Candow DG. Creatine Supplementation in Women's Health: A Lifespan Perspective. Nutrients. 2021 Mar 8;13(3):877. doi: 10.3390/nu13030877. PMID: 33800439

Vidafar P, Gooley JJ, Burns AC, Rajaratnam SMW, Rueger M, Van Reen E, Czeisler CA, Lockley SW, Cain SW. Increased vulnerability to attentional failure during acute sleep deprivation in women depends on menstrual phase. Sleep. 2018 Aug 1;41(8):zsy098. doi: 10.1093/sleep/zsy098. PMID: 29790961

Xu C, Bi S, Zhang W, Luo L. The effects of creatine supplementation on cognitive function in adults: a systematic review and meta-analysis. Front Nutr. 2024 Jul 12;11:1424972. doi: 10.3389/fnut.2024.1424972. Erratum in: Front Nutr. 2025 Feb 17;12:1570800. doi: 10.3389/fnut.2025.1570800. PMID: 39070254