Should creatine be part of a menopause supplement stack?

Talking about bone density loss is not sexy. Hot flashes and brain fog aren't super empowering either, but at least they're getting some airtime in menopause media. Bone density, muscle mass, and the complications that can follow are more silent. They're slow-burning menopause symptoms, if you will. They don't quite smack you in the face so much as they sneak up on you when you're trying to pick up a loaded armful of groceries and realize, "Wow, that feels different."

Supplementation is one of the many ways women (and the clinicians who treat them) help reduce menopause symptoms. Whether it's supplements or hormone replacement therapy, finding the right methods to support your body during this drastic change is important. So it got Hone Health wondering: Is there anything out there for maintaining muscle and mitigating age-related bone issues?

We looked around the gym for inspiration—specifically at the age-old body-builder's favorite supplement, creatine.

How Does Menopause Impact Muscle And Bone Health?

Menopause hormone shifts bring about a lot of symptoms and changes. Think: joint pain, fatigue, and even nausea. The main culprit? Estrogen. As women's ovaries phase out of operation, levels of the hormone drop significantly.

Estrogen plays a crucial role in maintaining bone density. It helps balance bone formation at a cellular level. When estrogen levels decline during perimenopause, bone resorption (or breakdown) increases, leading to a decrease in bone density. Estrogen also has an indirect role in maintaining muscle mass. A decrease in estrogen levels during menopause often leads to a gradual loss of muscle mass and strength, which can lead to skeletal muscle conditions like sarcopenia or dynapenia—or muscle loss and strength loss.

What Is Creatine?

Creatine is a compound naturally produced in the body composed of three amino acids: arginine, glycine, and methionine. Its main role is to help our muscles efficiently produce energy during intense exercise or strenuous activity by producing a compound called ATP (adenosine triphosphate). ATP is the fuel our muscles need for short bursts of activity, explains Brittany Werner, a registered dietitian.

That's why athletes of all levels often take creatine before a workout to enhance their performance in activities that involve high-intensity effort, such as weightlifting, sprinting, jumping, resistance training, and other explosive movements.

Another reason athletes and bodybuilders take creatine is to help build muscle mass. Studies show that creatine aids in muscle growth by increasing water content in muscle cells and promoting protein synthesis.

Women have between 70–80 percent less creatine stores than men and tend to consume less through their diets, too, explains Kristin Kirkpatrick, a registered dietitian. So it is even more important for them to supplement, especially during periods of hormonal fluctuations, like during menses, pregnancy, postpartum, perimenopause, and post-menopause.

Can Creatine Help Women Prevent Menopause-Related Muscle and Bone Loss? 

Yes. Women over 40 can benefit the most from creatine's well-documented benefits, including increased lean mass, faster muscle growth, improved bone density, and overall improved wellness, says Werner. Many experts advocate for creatine as an essential supplement for aging women because it addresses some of the key physiological challenges faced by women in this age group.

In a comprehensive overview study, creatine supplementation in older women was shown to counteract menopause-related decreases in muscle, bone, and strength. Results showed the supplement was effective in reducing inflammation, oxidative stress, and serum markers of bone resorption while also resulting in an increase in bone formation.

That said, dosage is important, and more long-term studies with larger groups of people are needed to determine if creatine, with or without resistance training, can truly improve muscle and bone health in postmenopausal women.

"It's not easy to get all the creatine your body needs from your diet—and this is especially true if you follow a vegetarian (or primarily vegetarian) or plant-based diet," says Kirkpatrick. "While the human body can synthesize about half of its daily creatine needs, the rest must come from dietary sources (often found in meat, fish, and other protein-rich foods) and/or supplementation."

Creatine Dose for Postmenopausal Bone and Muscle Health

Studies that focused on low doses of creatine (3g) taken over a long period of time (think two years) showed little effect on bone density or muscle gain in older women. Research that worked with larger doses of creatine based on individual body mass over shorter periods of time (around one week) showed significant increases in women's ability to perform strength-training exercises and bone strength. This is known as a loading phase and can come with some temporary adverse side effects, like cramping.

Creatine supplement plus resistance training yielded the best results. Not only does resistance training help strengthen bone and muscle mass, but it also aids in creatine absorption. Safe, consistent resistance training plus a short-term high-dose loading period supplementation followed by maintenance dosing is the sweet spot for reaping the benefits of creatine.

Individual dosage is based on unique health risks, other medications or supplements you're taking, as well as other lifestyle interventions. "In fact, creatine dosage may change throughout the course of working with someone," Kirkpatrick says.

Are There Any Side Effects?

There are two popular forms of creatine: Creatine HCL and creatine monohydrate, explains Kirkpatrick. "Creatine HCL is what I typically recommend since it is more soluble with higher absorption and fewer side effects." 

Potential side effects when loading creatine include water retention, GI distress (such as bloating and diarrhea), and increased stress on the kidneys, explains Werner. While studies point to higher doses, or a loading period, being more effective, more research is needed to support the benefits of loading (or large doses) of creatine without side effects. One note: if you have kidney issues, be sure to ask your doctor before supplementing.

Loading creatine is often seen as a beneficial way to jump-start the benefits of adding creatine to your routine but should not be seen as a long-term solution. To avoid potential side effects, experts recommend taking 5g of creatine daily long-term. This maintenance dose has been shown in practice to provide benefits without the side effects of a large dose.

Are There Any Other Benefits of Creatine?

Creatine's health-promoting effects beyond fitness and muscle-building are the subject of the supplement's most recent research and are still very much in the early stages of understanding. That said, there is some promise.

Studies link creatine to enhancement in energy levels (through the production of ATP, which is a primary action of creatine), maintenance and growth of muscle mass, and enhancement to brain health. It may even strengthen the immune system and promote heart health—though these areas of research are very new, and shouldn't be taken as fact. "Think of creatine as a turbocharger for your cells," says Kirkpatrick. 

Stabilize and increase mood

The increased prevalence of depression among women has been directly linked with hormonal milestones in some cases. Mood swings are a common symptom of perimenopause. Since creatine is a molecule that helps supply energy to cells, including brain cells, studies found that sufficient levels of creatine in the fluid surrounding the brain and spinal cord are related to increased levels of dopamine and serotonin (neurotransmitters involved in mood regulation). Basically, creatine helps in the transmission of neurotransmitters that affect mood, meaning that a well-functioning and supplied creatine system might be helpful for mood stability. This assertion, though, is still very much the subject of research to further prove the connection.

Ward off brain fog

Females are known multitaskers and systematically process stress differently than males. They're also susceptible to sleep deprivation due to hormonal fluctuations, like those during menopause (hello, hot flashes and cold flashes). Poor sleep often leads to a decrease in mental alertness. Overall, creatine supplementation has been shown to improve cognitive performance and brain function, as well as reduce mental fatigue, especially under conditions of stress, sleep deprivation, or during aging.

Other Natural Ways to Reduce Bone Loss During Menopause 

It turns out there are a few things you can do to help prevent muscle and bone loss during and after menopause. Werner has had great results implementing weight-bearing activities such as lifting weights, running, and even walking to help rebuild and replenish bone density with her menopausal clients. A diet rich in protein and nutrients can be beneficial too.

The Bottom Line

No one supplement can solve the health risks associated with women after the age of 45, but there is strong clinical and experiential evidence to support the effectiveness and safety of including low- to moderate-doses of creatine—3g to 5g—in your menopausal supplement stack to improve bone density and muscle mass (and maybe more benefits that are still being studied). Adding resistance training, getting in adequate protein and other nutrients, and quality sleep, is the best way to maintain strength and bypass issues with age-related bone health.