As women age, they face various physiological changes impacting their strength, metabolism, and overall well-being. Hormonal fluctuations, particularly during menopause, contribute to muscle loss (sarcopenia), decreased bone density (osteoporosis), a slower metabolism, and increased fat accumulation – all of which can significantly affect daily function and long-term health. These changes are closely tied to age-related hormonal shifts, including decreased estrogen, growth hormone, and insulin-like growth factor-1 (IGF-1), which play vital roles in muscle maintenance and bone remodeling. 

Creatine supplementation is a powerful yet often overlooked tool for supporting overall health in women. While commonly associated with promoting athletic performance, research increasingly highlights its benefits for muscle and bone health, as well as cognitive function (including memory, mental clarity, and neuroprotection) throughout a woman’s lifespan. By incorporating creatine into their routine, women can take a holistic approach to maintaining physical health, energy production, and brain health as they age. 

Creatine’s Role in Energy Production

Creatine is a naturally occurring compound synthesized primarily in the liver, kidneys, and pancreas. It is derived from the amino acids L-arginine, L-glycine, and S-adenosyl-L-methionine. About 95% of the body’s creatine is stored in skeletal muscles, while the remaining 5% is found in the brain, kidneys, and other tissues. Within muscle cells, creatine exists primarily as phosphocreatine (PCr), a high-energy compound that serves as a critical energy reservoir. Research shows that women exhibit 70% to 80% less endogenous creatine stores than men, suggesting how supportive supplementation may be for women.

During short bursts of high-intensity exercise, energy demands rapidly exceed what can be supplied through aerobic metabolism. For instance, power output can exceed 250% of maximal oxygen consumption. In these moments, PCr donates a phosphate group to adenosine diphosphate (ADP) through the creatine kinase reaction, regenerating adenosine triphosphate (ATP) – the body’s primary energy currency. This system provides an immediate, rapid energy source, particularly for activities lasting a few seconds or less, such as sprinting or jumping. However, once PCr stores are depleted, energy production shifts to anaerobic glycolysis, where glucose is broken down into pyruvate for ATP regeneration.

When oxygen availability is low, or energy demands are high, pyruvate is converted into lactate, leading to an accumulation of hydrogen ions (H+). This buildup contributes to muscle fatigue experienced during intense exercise. Creatine supplementation may mitigate this process by increasing PCr availability, which allows muscles to regenerate ATP more efficiently, helps serve as a buffer against H+ ion accumulation, and potentially sustains high-intensity efforts for longer durations.

Supporting Muscle Health 

Age-related hormonal changes impact muscle health in women, making creatine supplementation a valuable tool for maintaining strength and function. Research suggests creatine is most effective for high-intensity, short-duration activities or repeated bouts of high-intensity exercise with short rest periods. A clinical trial on NCAA Division I athletes (10 male and 10 female) found that those taking creatine supplementation displayed a statistically significant increase in body mass (0.9 +/- 0.1 kg, P < 0.03), total work during the first sprint (P < 0.04), and peak power during sprints 2 to 6 (P < 0.10). Notably, the female athletes saw greater benefits as sprints were repeated.

Creatine may also support strength training adaptations in older women. A 24-week, double-blind, randomized, placebo-controlled trial in vulnerable older women (n = 60) observed that the creatine plus resistance training (CR + RT) group exhibited significantly increased 1-rep max (1RM) leg press strength by 19.9%, compared to placebo (+ 2.4%) and creatine alone (+ 3.7%), but not in the placebo and resistance training group (+ 15%). The CR + CT group also showed superior gains in the 1-RM bench press (+10%) when compared with all the other groups (p ≤ 0.05). This suggests that creatine plus resistance training can help women promote their muscle mass and potentially attenuate age-related declines in strength.

Supporting Bone Health 

Creatine, best known for muscle support, may also benefit bone health. By enhancing muscle strength and power, creatine facilitates more vigorous resistance training. This increased mechanical loading stimulates bone remodeling, promoting bone growth and potentially mitigating age-related bone loss.

A 2-year randomized controlled trial of 237 postmenopausal women (mean age 59 years) examined the effects of creatine monohydrate supplementation (0.14 g/kg/day) or a placebo combined with resistance training and walking. Results showed improved bone geometric properties at the proximal femur and increased lean tissue mass in the creatine group compared to placebo (p = 0.046). Emerging evidence also suggests creatine may have a direct cellular effect on bone by potentially stimulating osteoblast activity, the key cells responsible for bone formation. 

Supporting Healthy Weight Management 

As women age, hormonal shifts and changes in body composition — including increased fat mass and decreased muscle mass — can make weight management more challenging. A common misconception is that creatine causes weight gain, largely due to its effect on water retention. However, research shows that creatine increases total body water (TBW) levels by drawing water into muscle cells, a process that enhances muscle hydration rather than fat accumulation.

Thus, creatine’s effects on body composition may be considered favorable. A recent meta-analysis by Forbes and colleagues examined creatine’s effects on body composition in adults at least 50 years of age. Findings suggest that the individuals who were taking creatine supplementation during resistance training experienced a greater reduction in body fat percentage (0.55%, p = 0.04) compared to those on placebo during resistance training. Additionally, the adults supplementing with creatine lost about 0.5 kg more fat mass than those on a placebo. However, it was not statistically different (p = 0.13). The researchers emphasized that combining creatine with resistance training further enhances muscle growth and improves metabolic processes, such as glucose uptake and fat metabolism, contributing to fat loss and overall body composition improvements.

Supporting Athletic Performance 

Creatine promotes athletic performance in women, whether in competitive sports or daily physical demands. Clinical trials show that women who incorporate creatine into their training experience significant improvements in strength, power, and lean muscle mass. A randomized, double-blind crossover trial of 24 subjects (including 12 females) assessed creatine’s impact on high-intensity exercise. Researchers found that both male and female subjects receiving creatine supplementation exhibited increased peak anaerobic cycling power (+3.7%, p < 0.05) and dorsiflexion maximum voluntary contraction (MVC) torque (+6.6%, p < 0.05). These findings demonstrate that creatine supplementation may support women across various athletic disciplines, including strength training. In a five-week study of 16 collegiate women lacrosse players, the creatine group significantly outperformed the placebo group in 1RM bench press gains (+6.2 ± 2.0 kg vs. +2.8 ± 1.8 kg). The creatine group also displayed decreased percent body fat (assessed through skinfold) compared to the placebo group. 

Research also suggests that creatine may help reduce neuromuscular fatigue (NMF) during endurance activities. In two separate studies, Stout et al. (n = 15) and Smith et al. (n = 15) concluded that the female athletes who supplemented with creatine exhibited delayed onset of NMF during incremental cycling exercise. This effect may be linked to increased intramuscular phosphocreatine (PCr) levels, which help delay anaerobic glycolysis and reduce lactic acid and ammonia buildup, ultimately enhancing endurance performance.

Conclusion 

Creatine supplementation supports women’s physical and cognitive health across various life stages. Research highlights its benefits for muscle mass, strength, bone health, and athletic performance. However, it is important to note that the data on pregnancy remains limited. Creatine is emerging as a valuable tool and a top consideration for healthy aging in women across the lifespan.

Learn more about creatine and its additional benefits for brain health here:

The Versatility of Creatine: Going Beyond Sports Nutrition 

Creatine Monohydrate for Healthy Aging and Brain Function 

Effects of Creatine on Brain Health and Function 

By Ally LaGrutta, MS, CNS, CSCS