ATENEA Study: Adherence to Creatine-Based Nutritional Supplementation in Estrogen-Depleted Women

This is a prospective, multicenter, observational clinical study aimed at evaluating adherence to a creatine-based nutritional supplementation (Creaticare FEM) in estrogen-depleted adult women, including those in menopause or late perimenopause.

Creaticare FEM is a multi-ingredient dietary supplement formulated to support musculoskeletal, metabolic, and skin health in this population. The daily dose (10 g) contains creatine monohydrate (3 g), hydrolyzed collagen (5 g), hyaluronic acid (95 mg), beta-alanine (300 mg), magnesium (200 mg), and vitamins A, C, E, and B6.

Participants will receive the nutritional supplement for a period of 12 weeks, without any modification of standard clinical practice. The primary objective is to describe adherence to supplementation, defined as the percentage of prescribed doses consumed during the study period and the proportion of participants achieving high adherence (≥80%) at the end of follow-up.

Secondary objectives include the assessment of persistence with supplementation, participant-reported acceptability and satisfaction, tolerability through the monitoring of adverse events, and adherence to a general recommendation of physical activity provided as part of routine care.

In addition, exploratory analyses will be performed to describe pre-post changes over the 12-week period in selected clinical variables, including muscle strength (handgrip dynamometry), body composition (bioimpedance), quality of life (Cervantes questionnaire), joint pain (visual analog scale), and skin health perception (cosmetic VAS). These exploratory outcomes are descriptive in nature and intended to generate hypotheses for future controlled studies.

The study does not involve randomization, control group, or experimental intervention beyond routine supplementation, and therefore is not intended to establish causal relationships or confirm clinical efficacy, but rather to provide real-world evidence on adherence, acceptability, and tolerability of a multimodal nutritional supplement in this population.

Inclusion criteria

• Biological female sex.
• Age ≥40 years.
• Estrogen-depleted status, defined as at least one of the following:

natural menopause, defined as amenorrhea for ≥12 consecutive months; surgically induced menopause; late perimenopause with elevated FSH according to clinical judgment.

• Absence of major comorbidities that would contraindicate use of the nutritional supplement or the recommended physical activity.
• No relevant changes in usual treatment during the previous 3 months.
• Ability to understand the study information and provide written informed consent.
• Willingness to take the nutritional supplement according to the study instructions.
• Willingness to follow general physical activity recommendations provided by the investigator.
• Willingness and ability to attend the planned visits and complete study assessments through Week 12.

Exclusion criteria

• Initiation or modification of treatment with GLP-1 receptor agonists within the previous 12 weeks.
• Presence of musculoskeletal or joint conditions that significantly limit the ability to perform regular physical activity or study-related functional assessments.
• Clinically relevant renal or hepatic disease.
• Current use of diuretics or potentially nephrotoxic medications.
• Known allergy or intolerance to any component of the nutritional supplement.
• Participation in another clinical study (nutritional, pharmacological, or interventional) within the previous 3 months.
• Any medical condition or social circumstance that, in the investigator's judgment, could interfere with study participation, adherence, or data validity.