Creatine and perimenopause: what the small studies found

First, what is perimenopause?

Perimenopause is the bumpy road into menopause. If you’re in your 40s and your cycle has started doing improv, you may be on it, along with a very large crowd. Most women start between 45 and 55, and the average age of menopause in the US is 52.²

It starts when the length of your cycle begins changing by a week or more, again and again. It ends 12 months after your last period.¹

The hard part is how long it lasts. In a large US study, frequent hot flashes lasted more than seven years for the typical woman, and more than 11 years when they started early.³

Sleep tends to get worse, too.⁵ The risk of serious depression is 2 to 4 times higher than before.⁶ Even memory gets a little stuck: the usual boost you get from practicing a memory test quietly disappears, then comes back after menopause.⁷

Where did the creatine idea come from? A rat mystery

For years, researchers studying estrogen in rats tracked a mystery marker they called the “estrogen-induced protein.” In 1981, someone finally identified it: the brain version of an enzyme that runs creatine’s quick-energy system.⁹

Two years later, a study found that an hour after a shot of estrogen, young female rats made more of it in parts of the brain that respond to estrogen.¹⁰

Hence the idea: if estrogen helps run this energy system, falling estrogen might leave the brain short on quick energy, and creatine might fill the gap.¹¹¹² One review calls its own model “theoretical,” which is exactly the right word.¹²

What do brain scans in women show?

A confusing picture. In 2026, a small study scanned 12 women in perimenopause. Their brain creatine was a bit lower than in younger adults, and lower creatine in some areas went with more trouble concentrating.¹⁴

But in one area, higher estrogen went with less creatine, the opposite of the simple story, and there was no comparison group.¹⁴

A bigger study of 156 women found the reverse: women with memory complaints had relatively more of the brain’s quick-energy reserve, not less.¹⁵ So brain energy does change around menopause. Nobody can say yet that creatine would fix it.

The rat studies are elegant. The human studies are twelve women and a puzzle.

The studies in actual women: 36, then 15

In mid-2025, a big review said it plainly: no research had tested creatine in women in perimenopause.¹³ Two small studies have come out since.

The first was a proper trial. Researchers took 36 healthy women, average age 50, some in perimenopause and some past it. For 8 weeks, each took one of three low doses of creatine or a dummy powder, about 9 women per group.¹⁶

The women on 1.5 g a day beat the dummy-powder group on reaction time, and had more creatine in their brains. Mood swings looked a little better too, but not enough to count as a real difference.¹⁶ Three catches:

• It used a less common form called creatine HCl, at low doses, not the usual 3 to 5 g of creatine monohydrate.
• Women in and after perimenopause were counted together.
• Its main goal was to measure tiredness, and the published summary doesn’t report it.¹⁶

The second study had 15 women, 5 of them in perimenopause. They took the usual form of creatine and lifted twice a week for 14 weeks. Leg strength went up, the perimenopause group said they slept better, and estrogen didn’t change.¹⁷

But there was no dummy-powder group and no dose listed, so we can’t tell the creatine from the lifting. (Which, for the record, is a perfectly good reason to lift.)

The study we’re all waiting for

A University of North Carolina trial signed up 55 active women aged 38 to 60, all in perimenopause. They did hard strength training twice a week, and some took creatine (a loading week, then 5 g a day) while others took a dummy powder. It measured muscle, strength, symptoms, mood and anxiety.¹⁸

It finished in December 2025. As of October 2026, the results still aren’t published.¹⁸ A UK trial testing about 6 g a day on thinking skills in women aged 35 to 65 is recruiting now.¹⁹ When those results land, we’ll update this article the same week.

So what does help in perimenopause?

The options with proof just aren’t in a supplement tub. The Menopause Society says hormone therapy is the most effective treatment for hot flashes.⁴ For women in perimenopause with depression, estrogen therapy helps about as much as antidepressants.⁸ The society does not recommend supplements or herbs for hot flashes, and doesn’t mention creatine.⁴⁸

Curious anyway? The usual 3 to 5 g a day is well tolerated and works best with strength training.²⁰ Treat it as an experiment, not a treatment.

What we don’t know yet

• Whether creatine helps any perimenopause symptom: no big enough study of the usual form has been published.
• Hot flashes: no study with a dummy powder has reported them.
• Whether perimenopausal brains are actually low on creatine: the scans disagree.¹⁴¹⁵
• Creatine with hormone therapy: not studied.
• The North Carolina results: finished, not published yet.¹⁸