Creatine | Sleep | A Note On Aging | A Healthy Alcohol Alternative | Spring Recipe

I get hundreds of great questions every week. And to be honest, the one category that comes up more than almost any other isn't about a specific diagnosis, nor is it even about a specific symptom. It's some version of this: "Is this worth it? Or am I wasting my money?"

Creatine, red light therapy, collagen peptides, mushroom coffee, magnesium glycinate, GHK-Cu. The list grows every week, and so does the confusion. And here's the thing: that confusion is not your fault. The wellness industry generates billions of dollars by making women feel like they're always one product away from feeling better. They offer big promises of being “just one supplement away from sleeping through the night, and one device away from reversing ten years…” It's exhausting, and a lot of it is nonsense.

So today, I'm launching this recurring series where I cut through exactly that noise. Every installment, I'll take a product, ingredient, supplement, or wellness trend you're actually asking about, and give you the honest, evidence-based breakdown. Not what the brand says. Not what the influencer is paid to say. What the data shows, and what I actually think.

This is by far the number one supplement you’re asking about right now, and that makes sense. Creatine has migrated from gym culture into mainstream women’s wellness conversations seemingly overnight. But here’s the thing: the research behind it isn’t new at all. Let’s break it down properly.

Creatine is a naturally occurring compound that your body synthesizes from amino acids, and you get small amounts through your diet, mainly from red meat and fish. Its central job? Energy production. Creatine helps replenish ATP, the molecule your muscles use for short bursts of intense effort. Most of your body’s creatine is stored in skeletal muscle, and supplementing increases those stores beyond what diet and your body alone provide.

Creatine monohydrate is well-tolerated in healthy adults. The most common side effect is temporary water retention, which can cause a slight increase on the scale in the first few weeks. Women with kidney disease should check with their physician before supplementing, as creatine affects creatinine levels, a key marker used to monitor kidney function.

Most research uses 3–5 grams of creatine monohydrate per day, although emerging data suggest that higher doses may be needed to achieve the cognitive benefits associated with creatine. (I take 4-5 grams a day personally.) There’s no need for “loading” unless you’re an athlete trying to saturate stores quickly. Consistent daily use at a moderate dose achieves the same benefits over time.

This is where creatine really shines. Decades of research show that when combined with resistance training, creatine improves muscle strength and lean mass more than training alone. For midlife women, this is crucial. From age 30-70, we lose about 1-2 percent of muscle every year in a process called sarcopenia. Preserving muscle isn’t just about aesthetics; it’s essential for metabolic health, vitality, and maintaining independence.

Emerging research suggests creatine may support bone resorption when paired with exercise. The data is promising, though more studies are needed before we can draw firm conclusions.

Small trials have indicated that daily creatine supplementation helps combat perimenopausal symptoms such as brain fog, accelerates cognitive processing, and improves mood stability. While it’s not a cure, the early evidence is very intriguing.

If you are doing resistance training, creatine monohydrate is one of the few supplements I can confidently say is backed by strong evidence for midlife women. The muscle-preserving and potential cognitive benefits align perfectly with what this stage of life demands.

If you’re not yet strength training, creatine is not a substitute. Prioritize establishing a resistance routine first, then add creatine as a supporting tool.

One practical note: Quality matters. Stick to creatine monohydrate, not “fancy” forms like creatine HCl or ethyl ester, which haven’t shown superior results in research. Look for brands that use third-party testing. I personally recommend Thorne*, which has been independently tested for heavy metals and comes back clean. NSF Certified for Sport or Informed Sport certification is a good benchmark for any brand you consider.

As always, run this by your physician if you have kidney concerns or take medications that affect renal function (though your doctor may not be current on the extensive creatine literature, sadly).

Most sleep advice for women over 55 is written for someone else.

The standard recommendations of limiting caffeine, keeping a consistent bedtime, and avoiding screens at least two hours before bed aren’t wrong, but they aren’t sufficient for a woman whose sleep architecture has been fundamentally reorganized by hormonal changes.

If you’re waking at 3 a.m. with a racing heart, lying awake for two hours and then crashing before your alarm, or sleeping eight hours and still feeling exhausted, this is not a discipline problem; it’s a physiological problem.

You are not alone. Sleep disturbances are reported by 40 to 60 percent of menopausal women, making this one of the most common and least adequately treated symptoms of the menopause transition. Before menopause, around 30 percent of women report sleep problems more than three times a week. During the transition, that rate doubles.

Sleep is not one uniform state; it’s a sequence of stages: light sleep, deep sleep, REM, each cycling through the night in a specific pattern. Estrogen and progesterone play active roles. Estrogen helps regulate body temperature and REM cycling, while progesterone acts on GABA receptors and has a natural sedating effect. When both hormones drop, sleep architecture doesn’t just shift slightly; it can fragment significantly.

Early-morning waking is often linked to cortisol. Cortisol should rise gradually in the early morning to help you wake, but low estrogen and a dysregulated stress response system can cause the spike to come earlier and be stronger than intended. Add a hot flash, and you may find yourself fully awake in the middle of the night.

It’s not your body working against you. It’s your body operating without the hormonal scaffolding it once had.

If you’re not on HRT and sleep disruption is significant, this is a conversation to have with your provider. Oral micronized progesterone has strong evidence supporting sleep: one randomized, double-blind, placebo-controlled study found women taking it had 53 percent less time awake after sleep onset and nearly 50 percent more slow-wave sleep. Subsequent reviews indicate that estrogen combined with progesterone improves sleep quality, whereas estrogen alone does not. Micronized progesterone, not synthetic progestins, is the formulation with the strongest data.

Wearables like the Oura Ring* can help track this. Research shows nearly 50 percent of women meeting criteria for insomnia had less than six hours of total sleep on objective measures, even if they believed they were sleeping more. Eight hours of fragmented sleep is not eight hours of rest.

Even low doses (roughly two drinks)  can disrupt REM sleep and delay REM onset by an average of 18 minutes. You may fall asleep faster, but your sleep quality suffers. If sleep is poor and you drink regularly, addressing alcohol should come before supplements or devices.

Chronic stress, under-eating, and over-exercising can elevate cortisol and directly disrupt sleep. Many high-functioning women who exercise intensely and eat clean still struggle to sleep. Sometimes the solution is to reduce intensity, not increase it.

Supplements can support sleep, but they cannot reconstruct sleep if the hormonal foundation is missing. Magnesium glycinate is my starting point because it’s well-tolerated, supported by reasonable evidence, and carries a low risk. Melatonin is often misused; most women take too much (5–10 mg) when evidence supports lower doses (0.5–1 mg) for sleep onset. Ashwagandha has emerging data for cortisol regulation and may help indirectly. 

These prescription medications can be safe and effective, but only in the short term. They have not been approved for nightly use for years. Using them this way carries a real risk of altering your brain chemistry in ways we don’t fully understand, and that’s not something any of us wants.

If you’ve been taking one for years, now is the time to consider a medication holiday, carefully. This doesn’t mean stopping abruptly. Instead, the safest approach is to gradually reduce the dose and adjust the frequency: every other day, every 2-3 days, or only when truly needed, such as for long-distance travel. We’ll dive deeper into safe tapering strategies in a future issue.

You deserve more than a pamphlet or a quick fix. You deserve a real, personalized workup to get to the root of the problem, not just temporary relief.

I’ve been doing a deep dive on the questions you’ve sent over the past several months. And I don’t mean skimming, but really reading them. What struck me wasn’t the volume, or even the complexity of the medical questions (though both are real). It was the emotional undertone running beneath almost every single one.

You are asking about HRT timing, about whether it’s too late, about what happens if you stop. You’re asking about hair loss in a way that makes clear this isn’t about vanity; it is about recognition. You are asking about GLP-1 maintenance, long-term safety, and what comes next after initial results. You want to know if your fatigue is normal or whether something is actually wrong.

On the surface, these questions are all different. But underneath, they’re circling the same thing: Am I going to be okay? And is anyone going to tell me the truth?

I feel that — deeply.

And here’s what I know from 19 years in clinical medicine, 26 years as a doctor, and as a 56-year-old woman navigating this same terrain: the medical system was not designed with us in mind.
It wasn’t designed for the complexity of midlife female physiology.
It wasn’t designed for the woman who is already informed, already in treatment, already doing the work,  and still not getting straight answers or the results she wants.

That gap is exactly why I built Ajenda.

Not to give you more information… because you already have access to plenty. But to help you think through it. To take a position when the evidence supports one. To say, “for most women in this situation, here’s what I’d actually do” and mean it.

Yes, I am a doctor, but I am also a real person. I ask the same questions about my own body; I feel the same uncertainty when the guidelines don’t quite fit my situation; and I’ve sat in the exam room on the other side of the table, feeling stressed and nervous.

So when you write to say that something I’ve shared made you feel seen, helped you walk into your doctor’s appointment with more confidence, or finally gave you language for something you’ve been feeling for years, that is not small to me. That is the whole point, and why I do what I do!

Thank you for being here.
Thank you for asking the hard questions.
Thank you for refusing to settle for “that’s just aging.”

Because it’s not ‘just aging’. And you deserve to know the difference.

If you read last week’s issue on my recommendations around alcohol, you know that the goal was not restriction or judgment. It was creating space for something that actually makes us feel better. For me, that’s Vesper*. 

It’s what I consider to be a great option when I want the elevated feeling of a delicious cocktail, a signal that the day is done. But with Vesper, there is no negative impact on sleep and nothing to contribute to a guilty feeling the next morning. And this isn’t just a placebo effect. Research from Brown University (among others) shows that even taking a short break from alcohol can improve sleep, mood, energy, and key markers of metabolic and cardiovascular health.

And what I appreciate about Pique is that it is actually formulated with intention. This isn’t just a non-alcoholic drink trying to imitate something else; it’s built to make you feel a certain way.

I’ve been enjoying Vesper after dinner or before a pre-bedtime bath. It makes these things feel more intentional (and even healthier!). And this is the part that surprised me: it doesn’t feel like you’re “missing” anything.

Each glass may support or provide:
• A subtle release of tension at the end of the day
• A positive shift in mood, without feeling altered
• That social ease you want if you’re out with people
• A calm, present feeling instead of that wired-tired edge

No haze, no sleep disruption, no next-day drag. I feel like myself, but better!

The formulation is thoughtful from a nutritional science standpoint:

• L-theanine, tart cherry, and lemon balm to support relaxation and nervous system balance
• Gentian root for a subtle sense of uplift
• Damiana to support a slightly more open, social feeling
• Elderflower for a bright, celebratory finish

It’s sparkling, slightly tart, a little herbaceous, and tastes like a real drink, not a substitute. Honestly, it’s one of the few alcohol alternatives I’ve tried that doesn’t feel like a compromise.

If you’re experimenting with drinking less, or even just being more intentional with it, this is an easy swap that still feels good. I partnered with Pique to offer you 10% off Vesper for life if you’re interested in trying it.  

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Ready to start a proven plan built for women in this season of life? Come join us inside The Wellness Experiment. It’s where strength training meets smart nutrition, real accountability, and a community of women aged 50, 60, 70+, doing this together. No extremes. No fads. Just proven strategies that help you feel strong, capable, and confident again. Plus weekly LIVE Q&A sessions with me and pro-trainer Korey Rowe.

In her former roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has authored several books, including the national best-seller, The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

^{This material is provided solely for informational purposes and is not providing or undertaking to provide any medical, nutritional, behavioral or other advice or recommendation in or by virtue of this material.  This newsletter is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this newsletter or materials linked from this newsletter is at the user’s own risk. The content of this newsletter is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.}

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