A meta-analysis of seven randomized trials involving 608 postmenopausal women found that creatine monohydrate supplementation increased lean muscle mass by 0.37 kg and leg-press strength by 7.5 kg compared to placebo. The benefits emerged specifically when participants took at least 5 grams daily combined with resistance training, while lower doses without exercise showed no measurable effects. This finding addresses a critical gap in menopause management, as women typically lose 1-2% of muscle mass annually after menopause due to declining estrogen and growth hormone levels. The muscle-preserving effects of creatine appear particularly relevant given that sarcopenia affects up to 45% of postmenopausal women and significantly increases fracture risk and functional decline. While the absolute gains seem modest, they represent meaningful preservation against age-related losses that compound over decades. The research quality was generally robust, with one large preregistered trial showing low bias risk. Notably, bone density remained unchanged despite creatine's theoretical benefits for bone metabolism, suggesting the supplement's primary value lies in muscle preservation rather than skeletal protection. This represents confirmatory evidence supporting creatine as a practical adjunct to resistance training for maintaining physical function during the postmenopausal transition.