Creatine for Perimenopause
Perimenopause is the transitional time before menopause when hormone levels (especially oestrogen and progesterone) fluctuate and gradually decline. This phase often comes with symptoms like:
Muscle loss
Bone density decline
Fatigue and reduced recovery
Brain fog, mood shifts, and sometimes mild cognitive decline
Sleep disturbances
Creatine, the supplement with the most research available, may help with these issues.
What is creatine and how does it work?
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Creatine is made in the body (liver, kidneys etc.) from amino acids, and is also consumed via the diet (meat and fish).
It’s stored mainly in skeletal muscle (where it helps regenerate ATP via the phosphocreatine system) but is also present in the brain.
Because it helps restore ATP during high-energy demand (exercise, mental effort, times of stress), it can support performance, recovery, and energy metabolism in both muscles and the brain.
Benefits of creatine for perimenopause and menopause
1. Muscle strength, mass and bone health
As women move through perimenopause, the loss of oestrogen contributes to muscle atrophy and a decline in strength. Maintaining muscle mass becomes harder but is very important for metabolic and bone health.
Creatine and resistance training has repeatedly been shown to improve muscle strength, performance and lean mass in women. For example, a review “Creatine Supplementation in Women’s Health: A Lifespan Perspective”(Smith-Ryan et al., 2021) found that pre-menopausal women benefit from creatine in terms of strength and performance. https://pmc.ncbi.nlm.nih.gov/articles/PMC7998865
Also, combining creatine with resistance (weight) training tends to help bone density indirectly via more force applied to bone plus better muscle support. Some evidence suggests direct effects on bone cell energy metabolism though data here is more limited.
2. Brain health, mood and cognition
Brain fog, reduced mental clarity and mood swings are frequent in perimenopause. Oestrogen has neuroprotective effects, and as it declines, women’s brains may be more vulnerable to metabolic stress and oxidative stress.
Creatine helps by boosting brain energy reserves (phosphocreatine), stabilising ATP availability during periods of high demand. There is emerging evidence that creatine improves memory, attention and processing speed, especially under stress. https://pmc.ncbi.nlm.nih.gov/articles/PMC10721691
A recent study (Gordji-Nejad et al., 2024) found that a single high dose of creatine (0.35 g/kg bodyweight) given after sleep deprivation improved cognitive performance and altered brain metabolism in ways that offset some of the negative effects of lacking sleep. https://www.nature.com/articles/s41598-024-54249-9
3. Combatting fatigue and improving recovery
Perimenopause often comes with increased fatigue and slower recovery (both physical and mental). Creatine helps muscles recover faster (less soreness, more ATP/energy regeneration) and reduces fatigue during resistance exercise.
By supporting energy metabolism in the brain as well, creatine may reduce ‘mental fatigue’ too.
4. Possible effects on mood and mental health
There is growing interest in whether creatine supports mood, and reduces anxiety or depression symptoms. Some studies show that adjunctive use of creatine with antidepressants in women accelerates symptom improvement. Also, during times of stress, creatine may help buffer mood shifts. https://pmc.ncbi.nlm.nih.gov/articles/PMC10721691/
The sleep-deprivation creatine study:
The study: Participants who were kept awake (21h of sleep deprivation) were given a single high dose of creatine monohydrate of 0.35 grams per kilogram body weight (so for a 70 kg person that’s around 24.5 g) or a placebo. Then cognitive tests and brain metabolic imaging were performed at multiple intervals.
What they found: Creatine prevented or reduced declines in processing speed, cognitive performance, also altered brain energy metabolism (phosphocreatine/ATP etc) that would otherwise drop during sleep deprivation. Some metabolic markers (PCr/Pi, ATP, etc.) were better preserved. The effect peaked around 3-5 hours post-dose, and remained noticeable over several hours.
What this means: It suggests that under times of acute stress due to lack of sleep, there may be benefit in higher doses of creatine (above the typical maintenance dose) to buffer cognitive impairment. This is only for acute, one-off periods though and shouldn’t be used long term – creatine is not a replacement for sleep.
Best dose of creatine for perimenopause: what the evidence suggests
Creatine dosing chart
Safety, side effects and other things to consider
Creatine is among the most studied dietary supplements, and is generally considered very safe in healthy individuals.
Side effects are usually mild and include water retention (which may slightly increase weight initially), and possible gastrointestinal discomfort if taken in large doses at once.
Those with compromised kidney function should check with their doctor before using.
Proper hydration is important when using creatine.
Higher doses (e.g. ≥20 g/day) tend to be used very short-term or in loading protocols; long-term safety data for very high doses is limited.
Practical tips for using creatine in perimenopause
Pair creatine with resistance training (weights or resistance bands) for best effect on muscle and bone.
Take the maintenance dose daily (3-5 g) at a time that’s convenient (morning, post-workout, with a meal). Consistency matters.
On days after poor sleep or under high cognitive/physical stress, a higher dose (as in the 0.35 g/kg study) may give short-term benefit — but only if you can tolerate it, and don’t use a high dose every day.
Conclusion
Creatine is not just for bodybuilders. For perimenopause, when you might be facing muscle loss, bone loss, mood changes, brain fog and fatigue, it offers multiple benefits:
Helps maintain/build muscle strength and mass
Indirectly supports bone health via muscle strength
Supports brain energy metabolism, helping with cognition and possibly buffering ‘brain fog’
May help reduce the toll of sleep deprivation or poor-sleep nights on cognition
May assist with mood and mental resilience
A safe, typical base dose is 3-5 grams/day.