Is creatine supplementation beneficial for women during perimenopause?

Creatine Supplementation During Perimenopause: Benefits and Evidence

Creatine supplementation during perimenopause may provide modest benefits for bone health and physical function, though evidence specifically for perimenopausal women is limited and mixed.

Benefits of Creatine During Perimenopause

Bone Health Effects

• Research on creatine supplementation for bone health in postmenopausal women shows variable results:
  • A 12-month study found creatine (0.1 g/kg/day) with resistance training attenuated femoral neck bone mineral density (BMD) loss compared to placebo (-1.2% vs -3.9%) and increased femoral shaft subperiosteal width, a predictor of bone bending strength 1
  • However, a more recent 2-year randomized controlled trial found creatine supplementation (0.14 g/kg/day) with exercise had no effect on BMD but did improve some bone geometric properties at the proximal femur 2
  • Another 2-year study using 3 g/day of creatine found no improvement in bone health in postmenopausal women with osteopenia 3

Muscle and Physical Function Benefits

• Creatine supplementation during resistance training has shown:
  • Increased relative bench press strength (64% vs 34% with placebo) 1
  • Improved walking time over 80 meters 2
  • Potential increase in lean tissue mass in valid completers of the study protocol 2

Safety Profile

• Creatine supplementation is generally considered safe and well-tolerated in healthy individuals 4
• Studies report normal creatinine clearance and no differences in liver enzyme abnormalities with supplementation 1

Considerations for Clinical Decision-Making

Dosing

• Studies have used various dosing protocols:
  • 0.1-0.14 g/kg/day 2, 1
  • Fixed dose of 3 g/day 3

Duration

• Benefits may require consistent long-term supplementation (studies ranged from 12 months to 2 years)
• Effects on bone geometry may take longer to manifest than effects on muscle strength

Combination with Exercise

• All positive studies combined creatine with resistance training and/or walking programs
• Creatine alone without exercise may not provide significant benefits

Limitations and Caveats

• Most research has been conducted in postmenopausal rather than perimenopausal women
• Results are inconsistent across studies, with more recent and larger trials showing less benefit
• No specific guidelines address creatine supplementation for perimenopausal women
• The USPSTF guidelines on menopausal hormone therapy do not address creatine supplementation 5

Bottom Line

For perimenopausal women concerned about bone health and muscle function, creatine supplementation (3-5 g/day) combined with regular resistance exercise may provide modest benefits for maintaining bone geometry and improving muscle strength. However, it should not be viewed as a primary intervention for preventing bone loss, as evidence for significant BMD preservation is inconsistent.