The creek is characterised by a drowned river valley estuary, consisting of steeply incised gorges with surrounding plateau areas. It is fed by a number of small tributaries that drain the steep catchments adjacent to the waterway. The tidal limit is at the Rocky Fall Rapids, some 23 kilometres (14 mi) from the creek's mouth.
The area around the creek is most developed near its source in the south, influenced by the development of Hornsby and its surrounding suburbs. As the creek flows to the north, it flows through a catchment area that is mostly bushland and includes parts of the Marramarra National Park, the Muogamarra Nature Reserve, and the Berowra Valley Regional Park. The steep sides of the creek have limited development directly adjacent to the Berowra Creek estuary, most of which is only accessible by boat. However the small settlements of Berowra Waters and Berowra Creek are both located on its banks. The creek is a popular destination for boating, fishing and other outdoor recreational activities.