The short version: In 2025, a team led by Dr. Abbie Smith-Ryan published a review in the Journal of the International Society of Sports Nutrition examining creatine across the female lifespan — menstruation, pregnancy, and menopause. Its conclusion: creatine is a promising and low-risk tool for women, with the strongest evidence in strength, body composition, and postmenopausal muscle and bone support, and the thinnest evidence in pregnancy and perimenopause.

If you are just starting to look into creatine, this is the single most useful paper to know about. It is not a study — it is a map of what researchers currently know, organized around the life stages women actually move through. That framing is unusual, and it is why the paper matters.

Why a women-specific review was needed at all

Most of what the general public “knows” about creatine comes from research conducted on young men. That is not a conspiracy; it is a historical artifact of how exercise science developed. The practical consequence is that dosing conventions, expected benefits, and side-effect warnings were all established in bodies with different hormonal environments and different baseline creatine levels than yours.

Two physiological differences drive the review’s argument:

Lower baseline creatine stores. Women are consistently reported to have lower endogenous creatine stores than men. You will often see this quoted as “70–80% lower,” a figure that traces back to earlier work by the same research group. It is worth understanding what that number does and does not mean: it refers to comparisons of total body creatine and dietary intake, not a claim that your muscles are 80% empty. The reliable takeaway is directional, not precise — women generally start lower, and lower baseline may mean more room to gain.

Hormonal influence on creatine metabolism. Estrogen and progesterone appear to affect creatine kinase activity and high-energy phosphate metabolism. This is the mechanistic reason the review organizes itself by life stage rather than treating “women” as a single category. A 24-year-old in the follicular phase and a 58-year-old three years postmenopausal are not the same physiological context.

Add a third, non-hormonal factor: creatine comes from red meat and seafood. Women eat less of both on average, and women are more likely to be vegetarian or vegan. Dietary intake compounds the baseline difference.

What the review found, stage by stage

The menstrual cycle

This is the most speculative section, and the review is upfront about it. Because estrogen and progesterone fluctuate across the cycle and appear to interact with creatine metabolism, there is a plausible mechanism by which creatine could help with cycle-related fatigue, mood dips, and training quality — particularly in lower-estrogen phases. But “plausible mechanism” is not “demonstrated benefit.” The human trials designed to test this properly have largely not been run yet.

What you should take from it: there is no evidence you need to cycle creatine or time it to your period. There is early reason to think consistent daily intake may smooth out some cycle-related energy variability. Treat that as a hypothesis worth watching, not a promise.

Pregnancy

Creatine plays a documented role in placental and fetal energy metabolism, and low creatine availability has been associated with poorer outcomes. The review discusses evidence that creatine supplementation may support pregnancy outcomes and reduce risk of placenta-related complications.

The critical caveat: much of this evidence base is animal and observational rather than randomized trials in pregnant women. The review explicitly names pregnancy as an area needing more research. This is a case where the biological rationale is strong and the human trial data is genuinely thin. Pregnancy supplementation is a conversation for your obstetric provider, not a decision to make from a blog post — including this one.

Perimenopause and menopause

This is where the review is most confident, and where the practical implications are clearest. As estrogen declines, women face accelerated loss of muscle mass, reduced neuromuscular efficiency, slower recovery, and increased bone turnover. Creatine is positioned here not as a performance enhancer but as a support nutrient for maintaining what you already have.

The consistent finding: creatine combined with resistance training produces greater gains in lean mass and strength in postmenopausal women than resistance training alone. For bone specifically, creatine appears to reduce markers of bone breakdown and support bone-building cell activity — again, in combination with loading. We break down the strongest single bone study, a 12-month trial, in detail here.

Note the pattern: the benefit is nearly always creatine plus training, not creatine alone. That is the most actionable finding in the entire review.

Mood and cognition

The review flags emerging evidence for creatine supporting mood and cognitive function in women. The brain, like muscle, runs on ATP and stores creatine, and brain energy metabolism appears disrupted in depression. We cover the cognition research and the mood and depression trials separately, because both areas have their own nuances worth understanding.

What this review does not establish

An honest reading requires naming the gaps, and the authors name them themselves:

• Optimal dosing for women is not settled. The review calls for work on dosing strategies. The 3–5 g/day convention is reasonable and well-tolerated, but it was not derived from female-specific dose-response research.
• Long-term health outcomes in women are under-studied. Safety at standard doses is well established; multi-decade outcome data specifically in women is not.
• Perimenopause is nearly a blank spot. Most menopause research uses clearly postmenopausal cohorts. The transition itself — arguably when symptoms are worst — is where data is thinnest.
• It is a review, not a trial. Reviews synthesize existing work. They inherit the limitations of the studies they summarize, including small samples and inconsistent methods. A separate 2025 systematic review of performance studies in active women reached notably more cautious conclusions, and holding both papers in view at once gives you a more accurate picture than either alone.

What to do with this if you’re researching creatine

The review supports a straightforward position: creatine monohydrate at a modest daily dose, paired with resistance training, is a low-risk intervention with a reasonable expectation of benefit for muscle, strength, and — after menopause — bone. The further you get from that core claim, the thinner the evidence gets.

If you want the practical version — form, dose, timing, what to look for on a label — Dr. Stacy Sims’ protocol article translates this research into specifics, and our full creatine guide for women walks through how to choose a product that meets the bar.

Frequently asked questions

Is this review the best source on creatine for women? It is the most useful single starting point, because it is women-specific, recent, and organized by life stage. It should be read alongside the more cautious performance-focused systematic review for balance.

Does it recommend a specific dose? No. It calls for research to establish optimal dosing in women rather than prescribing one. Practitioner guidance generally lands at 3–5 g/day of creatine monohydrate.

Does it say creatine is safe? It treats creatine’s safety profile at standard doses as well established, consistent with the ISSN position stand, while noting that long-term women-specific outcome data is limited.

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Read next

• The master research summary: everything the evidence says about creatine for women
• Does creatine actually improve performance in active women? A cautious systematic review
• Creatine, bone density and postmenopausal women
• Dr. Stacy Sims on creatine for women: her actual protocol

Sources

1. Smith-Ryan AE, et al. Creatine in women’s health: bridging the gap from menstruation through pregnancy to menopause. Journal of the International Society of Sports Nutrition. 2025;22(1):2502094. PubMed · Full text (PMC) · Publisher
2. Smith-Ryan AE, Cabre HE, Eckerson JM, Candow DG. Creatine supplementation in women’s health: a lifespan perspective. Nutrients. 2021;13(3):877. PubMed
3. NutraIngredients. From menstruation through menopause: review recaps effects of creatine in women. May 2025. Article

Educational information only. This article summarizes published research and is not medical advice. Talk to your healthcare provider before starting any supplement, particularly if you are pregnant, breastfeeding, managing a kidney condition, or taking prescription medication.