Creatine Supplementation Offers Women Unique Benefits at Every Life Stage
A comprehensive review reveals creatine's distinct advantages for women across menstruation, pregnancy, and menopause — far beyond muscle building.
Summary
This 2025 narrative review synthesizes decades of research on creatine supplementation in women, highlighting sex-specific differences in creatine synthesis and metabolism. Women produce roughly 20% less creatine endogenously and consume 30–40% less through diet than men. The review covers creatine's effects on exercise performance, cellular hydration across menstrual cycle phases, mood, cognition, pregnancy outcomes, and post-menopausal bone and muscle health. Recent studies controlling for menstrual cycle phase show creatine loading improves cellular hydration markers like phase angle and total body water, particularly in the luteal phase. The authors identify perimenopausal women and pregnant populations as critical research gaps and call for optimized, female-specific dosing strategies.
Detailed Summary
Creatine is best known as a performance supplement for male athletes, but a growing body of evidence suggests women may have even greater reason to supplement — and this 2025 review in the Journal of the International Society of Sports Nutrition makes that case comprehensively. Women synthesize approximately 20% less creatine endogenously and consume 30–40% less through diet (primarily from meat and fish) compared to men. Cyclical hormonal fluctuations during the menstrual cycle, pregnancy, and the menopause transition further modulate creatine synthesis, transport, and creatine kinase activity, creating windows of particular vulnerability and opportunity.
For premenopausal women, recent randomized controlled trials have begun to account for menstrual cycle phase — a methodological advance long overdue. Creatine monohydrate loading (20 g/day for 5 days) was shown to significantly increase total body water, extracellular fluid, and intracellular fluid, particularly during the luteal phase when fluid retention and bloating are common complaints. Bioelectrical impedance spectroscopy studies further demonstrated improved phase angle — a marker of cellular integrity — during both the follicular and luteal phases. Population-level data also linked suboptimal dietary creatine intake (<13 mg/kg/day) to higher risk of oligomenorrhea, pelvic infections, hysterectomy, and oophorectomy, suggesting creatine may have gynecological relevance beyond performance.
Beyond the menstrual cycle, the review highlights creatine's emerging role in pregnancy. Ellery and colleagues previously proposed creatine as 'an essential dietary metabolite of pregnancy,' citing its importance for placental health and fetal metabolism. Animal models support this, and the first human pregnancy studies are now underway. The review also summarizes evidence in post-menopausal women, where creatine combined with resistance training improves muscle strength, functional capacity, and bone density — outcomes critical for healthy aging and fracture prevention.
Cognitive and mood benefits are another key theme. Women are disproportionately affected by depression and cognitive decline, and creatine's role in brain energy metabolism positions it as a potential adjunct therapy. Studies suggest creatine may reduce depressive symptoms and improve working memory, with effects potentially amplified in populations with low baseline creatine stores — a category that includes many women.
The market dimension is notable: creatine sales rose 120% (~$20 million) from 2021 to 2022, driven partly by women consumers who are the largest demographic for dietary supplements overall. The authors note that reformulations (gummies, stick-packs) and science-backed messaging tailored to women's health have accelerated adoption. The review concludes by identifying perimenopausal women as the most significant gap in the literature — no controlled creatine trials exist for this population despite its clinical importance — and calls for longitudinal, dose-optimization studies across all female life stages.
Key Findings
- Women synthesize ~20% less creatine endogenously and consume 30–40% less dietary creatine than men.
- Creatine loading improved cellular hydration (phase angle, total body water) specifically during the luteal phase of the menstrual cycle.
- Low dietary creatine intake was associated with oligomenorrhea, pelvic infection, hysterectomy, and oophorectomy risk.
- Post-menopausal women show improved muscle strength and bone density with creatine plus resistance training.
- No controlled creatine trials exist in perimenopausal women — identified as the most critical research gap.
Methodology
This is a narrative review synthesizing historical and recent peer-reviewed research on creatine supplementation in women. It draws on the authors' own prior comprehensive reviews (2016, 2021) and highlights recent randomized controlled trials that controlled for menstrual cycle phase. No formal systematic review or meta-analytic methodology was applied.
Study Limitations
As a narrative review, this paper is subject to selection bias and does not provide pooled effect sizes or systematic quality assessments of included studies. Most existing trials did not control for menstrual cycle phase, used heterogeneous dosing protocols, and were short in duration. Perimenopausal women and pregnant populations are critically underrepresented, limiting generalizability of current recommendations to these groups.
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