The dose and the training are the whole story. A new meta-analysis of creatine in postmenopausal women found real gains in lean mass and strength - but only in trials using at least 5 grams a day alongside resistance training. Trials using 3 grams or less, with no training attached, showed no measurable effect at all. That split is more useful than any headline about whether creatine "works."
What the review covered. Seven randomized, placebo-controlled trials, 608 women, mean age around 62, running from 12 to 104 weeks with a median of 38. That is a small evidence base, and worth remembering before treating any of this as settled.
The muscle numbers. Lean mass favored creatine by +0.37 kg (95% CI +0.05 to +0.69), pooled from five trials and 338 women. Leg-press one-rep max improved by +7.5 kg (95% CI +2.2 to +12.8) across three trials. These are small effects. They are also about what you would expect from creatine in any population - it is not a compound that transforms bodies, it is one that lets you train a little harder and recover a little better, and the numbers follow from there.
Be honest about the lean-mass result. The prediction interval ran from -0.10 to +0.84 kg, which crosses zero. In plain terms: the average across these trials was positive, but a future trial could plausibly find nothing. The strength result held up better, with no heterogeneity between trials.
Bone density did not move. This is the disappointment, and it deserves saying plainly rather than being softened into "requires further investigation." Postmenopausal bone loss is why many women get interested in creatine in the first place, and this review found nothing. If bone is the goal, creatine is not the lever - resistance training, enough protein, vitamin D and, where appropriate, medical treatment are.
Safety looked unremarkable. Adverse events were mild and no different from placebo, and kidney markers were unchanged. Creatine's reputation for harming kidneys has never had good evidence behind it in healthy people, and nothing here revives it.
How strong is the evidence? Mostly "some concerns" on risk-of-bias assessment, with one large preregistered double-blind trial at low risk. The review was not prospectively registered. Treat this as a reasonable early signal, not a final answer.
The practical read. If you are postmenopausal, already doing resistance training, and want a cheap supplement with a decent safety record, 5 grams a day of plain creatine monohydrate is a defensible choice. If you are not training, the evidence here says do not bother - on its own the supplement did nothing. Buy the monohydrate; the fancier forms cost more and have never beaten it.
Medical note. This article is for general educational purposes and is not personal medical advice. Talk to your own clinician about supplements, especially if you have kidney disease or take regular medication.