Creatine has a bit of a reputation problem.

For years, it’s been seen as something reserved for bodybuilders or gym enthusiasts. The kind of supplement you’d only consider if you were lifting heavy weights or chasing performance goals. But that view is outdated. From a clinical perspective, creatine is not just a sports supplement. It’s a naturally occurring compound in your body that plays a key role for your muscles and cognitive function, memory, and mental clarity.

And when you’re moving through perimenopause or menopause, that becomes incredibly relevant.

As an expert pharmacist, nutritionist, and certified menopause practitioner, I’m seeing creatine shift from something niche to something genuinely useful for women in midlife – particularly when it comes to strength, energy, and cognitive function.

Let’s break down what it actually does, what the research says, and whether it’s right for you.

Why creatine matters more after 40

Perimenopause is often talked about in terms of symptoms. Hot flushes, irregular cycles, sleep disruption, brain fog. But underneath that, there are some significant physiological changes happening.

As oestrogen levels fluctuate and decline, you may experience range of symptoms, including:

• Loss of muscle mass and strength
• Increased fatigue or reduced exercise capacity
• Changes in body composition (e.g. midline weight gain)
• Brain fog or reduced ability to focus

Creatine plays a central role in how your body produces energy at a cellular level, which helps regenerate ATP (your body’s main energy source). As we age, both creatine production and muscle stores can decline. Combine that with the hormonal shifts of perimenopause, and you’ve got a situation where your energy systems, both physically and mentally, are under more pressure.

This is why creatine becomes such a useful supplement in this life phase. It can be supportive during a time when your body is working harder to maintain strength, resilience, and function.

What the research says

Muscle and strength 

One of the most important (and often overlooked) changes in midlife is the gradual loss of lean muscle mass. This is a natural process of ageing, which is accelerated as hormones change. 

When it comes to muscle health, it isn’t just about how you look. Muscle is critical for:

• Metabolic health
• Blood sugar regulation
• Physical independence as you age

Research consistently shows that creatine supplementation can support an increase in lean muscle mass, improved strength and better outcomes from resistance training

For women in perimenopause, this is powerful – especially when paired with even simple resistance training a few times per week.

Cognitive function, memory & mental clarity

If you’ve ever walked into a room and forgotten why you’re there, or struggled to concentrate in a meeting, you’re not imagining it. Brain fog is one of the most common symptoms I see in my clinic – and it’s linked to a combination of hormonal changes, sleep disruption, and stress.

Creatine is stored in the brain as well as muscle, and it plays a role in supplying energy to brain cells, cognitive processing and how well your mind fights mental fatigue. 

Research has found that creatine supplementation may improve aspects of cognitive performance, particularly in situations of stress or sleep deprivation. There’s also emerging research showing that creatine may help improve cognitive function, memory and mental clarity

Of course, it is not a magic fix, but it can be a helpful piece of the puzzle.

How much creatine should you take?

This is where things can get confusing when you’re searching online, or scrolling social media. 

For most women, it’s actually very simple:

• Dose: 3–5 grams daily
• Timing: Any time that suits you (consistency matters more than timing)
• Form: Creatine monohydrate is the most studied and reliable

You may read about what is called a loading phase – this is not necessary, and can often exacerbate side effects for some people. Creatine works by gradually saturating your muscles and tissues over time – so the key is consistency, not perfection.

Is creatine safe for perimenopausal women?

Short answer: yes – for most healthy women, it is very safe.

Creatine is one of the most extensively studied supplements available. It is suitable for long-term use in healthy individuals when taken at recommended doses.

That said, as a pharmacist, I always recommend checking in with your doctor if you have kidney disease or complex medical conditions.

Does creatine cause bloating? (Let’s talk gut tolerance)

This is one of the most common questions I am asked. Some women do experience bloating, mild gastrointestinal discomfort and/or a feeling of water retention.

In many cases, this comes down to starting with too high a dose, taking poor-quality formulations or individual gut sensitivity. 

How to improve tolerance

If you’ve tried creatine before and didn’t love how it felt, don’t write it off just yet. Try:

• Taking it with food.
• Drinking enough water.
• Choosing a high-quality creatine monohydrate product with minimal additives. 

A creatine option worth considering

From a practitioner perspective, quality and tolerance are vital when it comes to supplements. If you cannot tolerate something, you will likely stop using it. And when it comes to creatine, it is worth persisting – but of course, it is not for everyone, so always speak to your health professional to see what’s right for you. 

A few tips when looking for a good quality creatine product:

• Use a product that contains creatine monohydrate
• Ensure there are no artificial flavours or fillers
• Check the product is third-party tested for heavy metals and contaminants, and a dose that delivers the full 5 g the research supports. 

After reviewing what’s available in Australia, Biolae’s Creatone™ is a product I feel comfortable recommending to my clients.  It meets every one of those criteria, and includes ginger for those who experience digestive discomfort, which I find to be a common side effect of creatine among my patients. 

Can creatine help with perimenopause brain fog?

There is real potential in the research when it comes to this. Creatine supports brain energy metabolism, which can influence mental clarity and focus. 

If you’re dealing with brain fog, think of creatine as one piece of a broader strategy that includes:

• Adequate protein intake
• Good sleep support
• Stress management
• Hormonal support where appropriate

The bottom line

Creatine is one of those supplements that has quietly moved from the gym into clinical relevance. For women in perimenopause and menopause, it offers support for:

• Muscle and strength
• Energy and fatigue
• Brain function
• Long-term bone health

It’s not a silver bullet – but it’s an evidence-based option that can make a meaningful difference when used consistently. And importantly, it’s one of the few supplements where the research is strong, the safety profile is reassuring, and the benefits extend beyond one single outcome.

About Sarah Gray

Sarah Gray is a registered pharmacist (since 2005), registered nutritionist (since 2015), and certified menopause practitioner (since 2025). She is the founder of The Nutrition Pharmacist and works with women across Australia through her online clinic, helping them navigate perimenopause with evidence-based, practical strategies.

Sarah is also a practitioner partner with Biolae, contributing clinical insights into women’s health and menopause care.

References

• Antonio, J., et al (2021. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? Journal of the International Society of Sports Nutrition.
• Avgerinos KI et al. (2018). Effects of creatine supplementation on cognitive function. Experimental Gerontology.
• Candow DG et al. (2019). Creatine supplementation and aging musculoskeletal health. Endocrine.
• Chilibeck PD et al. (2017). Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults. Nutrients.
• Juneja, K et al (2024). Creatine supplementation in depression: a review of mechanisms, efficacy, clinical outcomes, and future directions. Cureus.
• Kreider RB et al. (2017). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation. Journal of the International Society of Sports Nutrition.
• Xu C et al. (2024) The effects of creatine supplementation on cognitive function in adults: a systematic review and meta-analysis. Frontiers in Nutrition.