Creatine After 40: What Women Need to Know About Muscle, Menopause, and Cognitive Support
- Sharon Ona, MS, CNS, CN, LD
- 3 days ago
- 9 min read
Creatine has gotten a lot of attention recently! Perimenopausal fitness influencers, menopause blogs and longevity newsletters, it seems like creatine is being mentioned everywhere. But is its recent popularity justified or it just another passing fad? The creatine conversation used to be relegated to bodybuilding forums, but research suggests that creatine’s benefits extend well beyond athletic performance into muscle preservation, bone health, glucose regulation, mood support, and cognitive processing, all of which become more important during perimenopause and menopause as estrogen fluctuates and declines.
I'm frequently being asked by my nutrition clients some iteration of the same few questions: Is creatine safe for my kidneys? How much creatine should I be taking? And is all this talk about creatine just hype?
I plan to answer these questions by exploring what creatine does in the body, who benefits from creatine supplementation, how to dose it properly, and what the risks are so you can make an informed decision about whether creatine supplementation may be right for you.
What Does Creatine Do in the Body?
It's important to understand what creatine does in the body. Our cells run on a molecule called ATP (adenosine triphosphate), which is the body’s energy currency. When ATP is being used, it needs to be regenerated quickly to keep going. The “going” can be lifting a dumbbell, climbing a flight of stairs, or processing a complex thought under stress.
Creatine helps this regeneration happen faster by donating a phosphate group to rebuild ATP through something called the phosphocreatine system. You can think of the phosphocreatine system as a backup battery that recharges your primary battery quickly so cells like muscle cells and brain cells have more readily available energy during moments of high energy demand.
Where Does Creatine Come From?
Creatine comes from two main sources: your body’s own endogenous production, and from dietary sources.
The body has a sophisticated two-organ system for making creatine. The kidneys and the liver work together to produce creatine using three amino acids: glycine, arginine, and methionine, which are released into the bloodstream and taken up mostly by skeletal muscle, and the remaining by organs like your kidneys and brain.
The remainder of your creatine supply comes from what you eat – primarily red meat, poultry, and fish (beef, herring, salmon, and tuna are among the richest sources of creatine).
Who Benefits from Creatine Supplementation?
The Research Foundation: What We Learned from Athletes
This is the population that creatine research started with and where the evidence for supplementation is the most robust. In athletes taking creatine, researchers found better strength output, faster recovery, and better performance in short, high-intensity activity. Your goal may not be to crush a PR in the gym, but the same underlying mechanism (helping muscle cells regenerate energy faster) is what supports strength and recovery during perimenopause and menopause.
Muscle and Bone Support Through Perimenopause and Menopause
As estrogen declines, muscle protein synthesis efficiency and bone density also decline. This means protein intake at meals becomes even more important to aid amino acid transport into muscle tissue. Creatine supplementation can help energy availability (aka ATP regeneration), which is critical for muscle protein synthesis.
Although creatine isn’t necessarily a bone-building supplement, its effect on skeletal muscle provides the mechanical loading needed for bone health. Pairing creatine supplementation with resistance exercise may indirectly reduce fracture risk by doing two things: by supporting stronger, more resilient bones (especially in the hip and thigh) and by strengthening the muscles that keep you steady on your feet, making fall risk less likely.
Guarding Against Age-Related Muscle Loss (Sarcopenia)
If you’ve worked with me, you’ve probably heard me talk about sarcopenia, the age-related decline in muscle mass and strength.
Skeletal muscle protein synthesis diminishes during perimenopause and menopause, with greater reductions seen in type II fast-twitch muscle fibers than slow-twitch type I fibers. As you age, this means slower reaction time, and reduced power and strength, which may lead to a loss of functional independence.
How can creatine help? Creatine benefits type II fast-twitch fibers, which are the fibers that are most vulnerable during menopause, by helping to maintain power and strength.
More power and more strength = more years of moving confidently, staying independent, and doing the things you enjoy.
Cognitive and Energy Support
Creatine crosses the blood-brain barrier and supports energy metabolism in the brain using the same ATP-regeneration process I described earlier.
This becomes relevant during perimenopause and menopause, when the brain is tasked with working harder than usual due in part to the hormonal shifts that cause hot flashes, night sweats, and sleep disruptions, which limit how well the brain is able recharge overnight. Declining estrogen affects how neurotransmitters involved in mood, focus, and memory are regulated, also causing the brain to work harder to maintain balance without the hormonal signaling it previously relied on. Together, these shifts mean the brain is burning through more energy during this stage of life.
Creatine’s anti-inflammatory properties matter here, as well, because menopause itself is associated with increased inflammation throughout the body, partly because of estrogen’s role in regulating the body’s inflammatory response. Lower inflammation is linked to improved brain function, adding another check mark on the list of creatine’s benefits.
The Kidney Question – What You Need to Know
One of the more frequent questions my clients ask me is, “Is creatine safe for my kidneys?”
As I mentioned earlier, the kidneys are involved in creatine synthesis. In fact, initial creatine production starts in the kidneys before it travels to the liver. So, your kidneys are already a part of creatine’s life cycle regardless of whether you are supplementing or not.
Whether creatine comes from your food, supplements, or your body’s endogenous production, a percentage of it naturally breaks down into a waste product called creatinine, which your kidneys filter out of the blood and excrete in your urine. When a creatine supplement is added to your daily regimen, it increases your body’s total creatine pool, which means your kidneys have a bit more to filter. On a blood test, this may translate to a slightly higher creatinine value. In healthy populations, this simply reflects the extra creatine being processed, not actual damage or declining kidney function. Testing other markers of kidney function in addition to serum creatinine, like eGFR and BUN, before starting supplementation and every 3-6 months is a wise decision.
Who should be cautious about creatine supplementation?
Anyone with existing kidney disease or reduced kidney function
Anyone with diabetes-related kidney changes (like diabetic nephropathy)
Anyone taking medications or supplements that stress the kidneys (such as certain blood pressure medications like ACE inhibitors, or chronic use of NSAIDs or other drugs that are filtered through the kidneys)
Anyone with a family history of kidney disease
Anyone who is pregnant or breastfeeding as safety data is limited
Anyone with hypertension or cardiovascular disease
And elderly individuals, due to the age-related decline in kidney function
Risk Level | Population | Recommendation |
Low Risk | Healthy adults, normal kidney function | Standard supplementation with proper hydration |
Moderate Risk | Age 65 and older, borderline kidney function | Lower doses, close monitoring |
High Risk | Known kidney disease, diabetes with complications | Avoid or use with physician supervision only |
If you’re low risk, the main considerations to keep in mind are staying properly hydrated in order to support your kidneys in doing what they’re already built to do, and monitoring with bloodwork. If your provider is concerned about increasing creatinine and they know it's due to creatine supplementation, another test called cystatin-c can measure kidney function without the results being clouded by creatine intake.
Dosing and Forms
There are a lot of creatine products on the market to choose from: gummies, powders, liquids, and proprietary blends using various forms of creatine. With so many options and savvy marketing strategies, choosing the right product can feel overwhelming.
Creatine monohydrate is the most well-studied form of creatine. Other forms, like creatine salts and esters are often marketed as having better absorption or fewer side effects, but there is limited evidence to support these claims.
What to look for:
A pure monohydrate formula without unnecessary fillers (preferably powder)
Third-party testing (look for NSF Certified for Sport or purchase from a reputable retailer like Fullscript)
Transparency about sourcing and manufacturing
How much should you take a day? For general health and muscle maintenance, a daily dose of 5 grams is a well-supported, evidence-based starting point, and it’s where I start most of my clients. However, doses up to 10 grams a day divided into 2-3 doses to optimize absorption are shown to provide the most therapeutic benefit while minimizing potential adverse effects like gastrointestinal upset. Creatine can be taken with or without food and consistency matters more than timing, so if you want to get the most out of your creatine supplement, just be sure to take it daily.
What about a loading phase? Loading phases of 20-30 grams are sometimes used, but this is not necessary and come with a greater likelihood of gastrointestinal distress. There’s also no significant long-term advantage with a large loading dose over starting with a 5-10 gram maintenance dose, which achieves similar tissue saturation over time, so loading isn’t something I recommend.
How long does it take to see benefits? Most people notice a difference within 4 to 6 weeks of consistent use.
Other considerations to support creatine’s effects: The combination of creatine and other nutrients, like carnitine (supports mitochondrial function), CoQ10 (supports cellular energy production), alpha-lipoic acid (antioxidant and metabolic support), taurine (cellular protection), and B-vitamins (which support the methylation process that is also used in the production of creatine), have synergistic effects. But it’s important to consult with a nutrition professional, like a Certified Nutrition Specialist to ensure you’re taking supplements that are right for you.
Not Sure If Creatine Is Right for You?
If you’re wondering if creatine might be right for you given your stage of life, health history, current medications and supplements, and recent labs, I'd love to chat.
About the Author
Sharon Ona, MS, CNS, LDN is a Certified Nutrition Specialist providing functional nutrition counseling through PCNM. She specializes in cardiometabolic health, inflammation, hormone balance, and personalized nutrition support for clients in Portland, OR and throughout the United States.
About Pacific Clinic of Natural Medicine
Pacific Clinic of Natural Medicine is a naturopathic and functional medicine clinic in Portland, Oregon, serving patients in-person and virtually throughout Oregon and Washington, with functional wellness consulting available nationwide. Our physicians are licensed naturopathic doctors — the original root-cause practitioners — specializing in hormones, gut health, nutrient status, thyroid, autoimmune conditions, chronic fatigue, and more.
📍 511 SW 10th Avenue, Suite 707, Portland, OR 97205 | 📞 503-894-8977 | pacificnaturalmedicine.com
FAQs:
Is creatine safe for my kidneys?
For most healthy people, yes. Your kidneys already process creatine as part of your body's normal production, and supplementing simply adds a bit more for them to filter — which can slightly raise creatinine on a blood test without indicating actual kidney damage. If you have kidney disease, diabetes-related kidney changes, or take medications that stress the kidneys, talk with your provider before starting, and consider baseline and follow-up labs.
How much creatine should I take?
Most people do well starting at 5 grams a day, with some benefiting from up to 10 grams split into 2–3 doses. A loading phase isn't necessary — consistent daily use matters more than timing or dose size.
How long until I notice benefits?
Most people notice a difference within 4 to 6 weeks of consistent daily use.
Is creatine only for athletes?
No. While the research base started with athletes, the same mechanism that supports strength and recovery also supports muscle preservation, bone health, glucose regulation, mood, and cognitive function — all especially relevant during perimenopause and menopause.
What form of creatine should I buy?
Creatine monohydrate is the most researched and reliable form. Look for a pure formula without unnecessary fillers, ideally third-party tested (NSF Certified for Sport or from a reputable retailer).
Should I be monitored while taking creatine?
If you're over 65, have borderline kidney function, or fall into a higher-risk category, yes — lower doses and regular bloodwork monitoring are recommended. Low-risk individuals should focus on hydration and periodic labs.
Is creatine right for me?
It depends on your health history, medications, and current labs. Book a consult with our team to find out if creatine supplementation fits your health goals.
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