Creatine for Women's Health

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

Creatine for Women’s Health

Creatine is one of the most popular and researched supplements for athletes, but it’s not just for bodybuilders! It’s well-known that creatine benefits muscle strength and building lean body mass. Still, new research suggests women can take advantage of this safe supplement for cardiovascular, neurological, and metabolic support.

Keep reading as we dive into creatine for women’s health. This article will discuss:

• What is creatine?
• How creatine changes with reproduction and aging in women
• Muscle and metabolic benefits for women
• Brain health benefits for cognition, memory, and mental health
• How to add creatine to your supplement regimen

Let’s dive into this exciting topic!

What is Creatine?

Creatine is a natural molecule made from the amino acids arginine, glycine, and methionine. We get creatine in our diet, especially from red meat, seafood, and other muscle meats. The body also makes creatine in the liver, kidneys, and brain. However, most of the creatine (around 90%) is stored in the muscles.

The primary function of creatine is to help regenerate ATP in cells, keeping energy constant. Creatine is essential in organs with high energy demands, including the muscles and brain.

ATP (adenosine triphosphate) is the energy currency of the body. Cells make ATP by metabolizing calories (carbohydrates, fat, protein). Then, cells break apart ATP to release the energy required for cellular function and health. Creatine helps put ATP together again so the cycle can continue.

Creatine is also available as a supplement (creatine monohydrate is the best form) to support optimal creatine levels in the muscles, brain, and body.

Creatine for Women

Women have less muscle mass and, therefore, less capacity for creatine storage in the muscles. They also naturally make less creatine than men (by 70-80%), and the average woman may consume less in her diet.

Hormones, particularly estrogen, influence creatine levels. Changes in estrogen levels throughout the menstrual cycle and life tend to mirror creatine production in women.

When estrogen is low, such as right before and during the period, postpartum, perimenopause, and post-menopause, it affects energy availability throughout the body, including the muscles and brain. Think about a time you may have experienced a poor workout before your period, postpartum mood changes, or perimenopausal brain fog. These could be beneficial times to supplement with creatine.

During pregnancy, the increased energy demands of the placenta and developing fetus require increased creatine levels. Poor creatine metabolism may impair fertility and pregnancy outcomes, while creatine supplementation may help improve women’s reproductive health.

Beginning in perimenopause and into post-menopause, women experience lower estrogen and the associated inflammation and oxidative stress. The low estrogen state also means a reduced ability to build muscle, and rates of muscle loss accelerate. Creatine, especially with resistance/strength training, may help counteract muscle loss.

Creatine for Strong Muscles and Metabolism

Creatine supplementation increases muscle mass, muscle strength, and athletic performance. It helps the body adapt to exercise, improving power and body composition. The benefits appear:

• Over the short and long term
• In athletes and non-athletes
• For both strength and endurance training

Supplementation also works best in conjunction with exercise training. Muscle contractions allow creatine to move from the blood into the muscles where it’s needed. The heart, as a critical muscle, also requires a lot of creatine.

For many women, muscle mass isn’t at the top of their health goals, preferring lifestyle strategies that promote thinness. However, muscle health and strength are essential for women’s health.

Optimizing muscle mass supports and protects metabolic health. It may aid in weight loss and achieving a healthy body composition. For women with PCOS (and everyone else), improving muscle mass supports insulin sensitivity and hormonal health.

As women age, muscle declines, impacting metabolism (i.e., increasing insulin resistance), weight, and aging. Building and maintaining muscle can help offset loss associated with aging and menopause and protect against osteoporosis and frailty.

Creatine for Brain Health

The brain accounts for only 2% of body mass but uses 20% of the energy supply. Creatine is critical for keeping energy in the brain consistent, and research shows that supplementing with creatine raises brain levels.

Creatine becomes even more critical for supporting ATP levels when there is a high metabolic demand in the brain, such as with:

• Sleep deprivation (women with small kids, high stress, or perimenopausal insomnia take note)
• Mental health concerns, including depression
• Concussion and traumatic brain injury (TBI)
• Neurological and neurodegenerative diseases
• Aging

Creatine supplementation improves ATP resynthesis in the frontal cortex of the brain, supporting cognition, attention, and memory.

In a double-blind crossover trial, participants received 5 grams of creatine or placebo daily for 6 weeks and then switched. The study found a small beneficial effect of creatine supplementation on cognitive tasks in the short study time and standard dosage.

A review of 6 randomized controlled trials also shows the cognitive benefits of creatine supplementation. Researchers found an improvement in short-term memory and reasoning skills with supplementation. Vegetarians responded better than omnivores, likely because of lower creatine levels in their diets. Additionally, older participants responded better to supplementation than younger ones.

A meta-analysis of 8 trials compared creatine supplements to placebo. Results point toward memory improvements in the supplemental group. The benefits were more significant in older adults.

Creatine supplements may also benefit mood and mental health by supporting brain energy and neurotransmitters, which is particularly important for women who have higher rates of depression and mood disorders than men.

While creatine can cross the blood-brain-barrier and enter the brain, improving brain levels of creatine is harder than improving muscle levels. The standard creatine dose for muscle gains is 5 grams per day, but brain research suggests that some may require higher dosages (up to 20 grams daily) for longer periods of time as a therapeutic intervention.

Best Practices for Taking Creatine

Creatine is a safe, low-risk supplement to try, as recommended by your TārāMD provider. It’s not a magic, fix-everything supplement, but it can support your goals in the context of a healthy, active lifestyle and as part of your overall integrative medicine protocol.

Side effects are minimal, but some women may feel bloated or experience digestive symptoms (such as constipation) when beginning. Creatine increases water storage in the body, so any initial weight gain associated with its use is water weight. Typically, the boy evens out after a week or two of use.

You’ll hear recommendations about “creatine loading,” where you take high doses of creatine to saturate the muscles and then reduce to a standard 5-gram dose for maintenance. The loading phase is not necessary and may cause increased side effects. Starting with a 5-gram dose will saturate the muscles in 3 to 4 weeks and is better tolerated.

Here are some tips for getting started:

• Choose creatine monohydrate from a trusted source
• Increase water intake to avoid dehydration and constipation while taking creatine
• Start with a quarter or half dose if you experience side effects and slowly work up
• Take creatine any time of day, mixed in water, a smoothie, or another beverage
• Taking creatine before or after exercise may have additional benefits
• Work with the TārāMD team for personalized guidance

While creatine’s muscle-building and strength benefits may help support body composition, aging, and menopause, its brain benefits are also something to consider. Increasing creatine in the brain via supplements may support memory, cognition, and mental health. It’s encouraging when a safe, natural compound has so many potential benefits! We’ll continue to watch as the research unfolds.

References

1. Forbes, S. C., Cordingley, D. M., Cornish, S. M., Gualano, B., Roschel, H., Ostojic, S. M., Rawson, E. S., Roy, B. D., Prokopidis, K., Giannos, P., & Candow, D. G. (2022). Effects of Creatine Supplementation on Brain Function and Health. Nutrients, 14(5), 921.
2. Smith-Ryan, A. E., Cabre, H. E., Eckerson, J. M., & Candow, D. G. (2021). Creatine Supplementation in Women's Health: A Lifespan Perspective. Nutrients, 13(3), 877.
3. Muccini, A. M., Tran, N. T., de Guingand, D. L., Philip, M., Della Gatta, P. A., Galinsky, R., Sherman, L. S., Kelleher, M. A., Palmer, K. R., Berry, M. J., Walker, D. W., Snow, R. J., & Ellery, S. J. (2021). Creatine Metabolism in Female Reproduction, Pregnancy and Newborn Health. Nutrients, 13(2), 490.
4. Balestrino M. (2021). Role of Creatine in the Heart: Health and Disease. Nutrients, 13(4), 1215.
5. Candow, D. G., Forbes, S. C., Ostojic, S. M., Prokopidis, K., Stock, M. S., Harmon, K. K., & Faulkner, P. (2023). "Heads Up" for Creatine Supplementation and its Potential Applications for Brain Health and Function. Sports medicine (Auckland, N.Z.), 53(Suppl 1), 49–65.
6. Sandkühler, J. F., Kersting, X., Faust, A., Königs, E. K., Altman, G., Ettinger, U., Lux, S., Philipsen, A., Müller, H., & Brauner, J. (2023). The effects of creatine supplementation on cognitive performance-a randomised controlled study. BMC medicine, 21(1), 440.
7. Avgerinos, K. I., Spyrou, N., Bougioukas, K. I., & Kapogiannis, D. (2018). Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials. Experimental gerontology, 108, 166–173.
8. Prokopidis, K., Giannos, P., Triantafyllidis, K. K., Kechagias, K. S., Forbes, S. C., & Candow, D. G. (2023). Effects of creatine supplementation on memory in healthy individuals: a systematic review and meta-analysis of randomized controlled trials. Nutrition reviews, 81(4), 416–427.