Oh dear… a book by a female herbalist written for womyn about womyn’s stuff. Anything a guy says may be regarded prima facie as partially or wholly suspect; but the author kindly submitted a copy to the Herbal Bookworm for review – so, somewhat daunted the Bookworm rises to the challenge….
The two outstanding features of this book are, firstly, the quite special way in which Amanda McQuade Crawford directly addresses women’s experience with a consistently gentle, sensitive and almost poetic turn of phrase : this is best illustrated by quoting a characteristic example from the text: here is one of my favourite extracts from the section on Sexuality and Vaginal Changes:
For many of us, lubrication must now be stimulated by great loving, not just any old hormonal flush of youth. It may take longer to bring the bucket to the top of the well, but, as they say, the water tastes sweeter since it rises from so deep. That thirst is one you can choose to let grow or ignore if there is no lover worthy of your bed.
To the male reader – this is awesome stuff; to women readers for whom the book is intended this must surely be one of the more appealing, sensible and user-friendly approaches on the subject available. Secondly, the author is emphatic in her explanation of menopause as a natural process, and thus wholly appropriate to be managed by herbs first and foremost; medicinal herbs are presented throughout as primary natural healing allies that are in essential harmony with our own life process, including its natural changes and transitions – of which menopause is an archetypical example.
The main part of the book is divided into three chapters – Premenopause, Menopause, and Postmenopause. A chapter on HRT is interspersed between Menopause and Premenopause. Each chapter follows a similar pattern – a brief and rather non-technical discussion of the relevant physiology with other general aspects is followed by a presentation of the different symptoms that are associated with each phase. For each of these, therapeutic suggestions are then given – first and foremost is a Herbal Medicine section which includes one or two formulae for the symptom described. These are presented both as tinctures and teas. Nutritional suggestions follow, divided into Wise Food Choices and Supplementation, with the emphasis on the former; the author adamantly favours nutrition rather than supplementation, lifestyle changes rather than OTC cure-alls. Finally, an In Addition section suggests other applicable techniques, ranging from physical approaches through stress management, visualisation and psycho-spiritual methods.
The second part of the book includes a Materia Medica section, describing the herbs used in the various formulae, and a set of appendices which include guidelines for home preparation of the herbal medicines in the text, suggestions for a home herbal medicine chest, a do-it-yourself personal menopause herbal formula guide, and addresses for obtaining reliable herbal material as well as educational resources. A select bibliography and index conclude the book.
The general context into which this book appears is now well known, as mainstream mass media continue to find menopause a newsworthy subject (translate: readership-advertising revenue etc) – although a decade ago the subject was rarely publicly debated, after the initial miracle cure publicity of hormone replacement therapy became muted by the emergence of its serious and potentially deadly side effects. As baby boomers reach middle age, the number of women who are in menopause is increasing rapidly – it is estimated that by the year 2010 more than 60 million US women will be menopausal.
Thus it is that recently traditional medical views of menopause as a purely medical condition caused by oestrogen deficiency and its therapeutic panacea of HRTare being challenged by wholistic women practitioners, feminists and women everywhere who counterpose the medical myth with their celebration of the aging process, understanding and reclaiming control over their own bodies, and assuming responsibility for their health and healthcare choices. The Herbal Menopause Book can be seen as a contribution to one essential aspect of this process – that of providing information about alternative views and natural healing approaches that is a necessary educational prerequisite of self-empowerement.
The demedicalisation of menopause is one thing; a fair question to ask then is what exactly is menopause once the conventional medical model is rejected? Perhaps the best that can be said is that this major transition is itself in transition – in terms of how it is understood. The skill of Amanda Mcquades book, is that it addresses the undeniable facts of the physiological and biochemical underpinnings of menopausal changes that are responsible for the asssociated symptoms that women experience, while both her style and the uniquely inclusive range of topics answer the emotional and psychospiritual aspects of the process, steering a delicate course between among the many different levels involved whilst avoiding remythologising menopause anew – a tendency perhaps of some of the more Wiccan or new-age approaches.
Amanda McQuade Crawford is well qualified both through her training in British medical herbalism and extensive clinical experience in her California based clinical practice to present the herbal choices on menopausal problems to a general readership. West-coast Wise Woman meets European Phytotherapy – makes for an interesting and informed perspective, even if sometimes the seams show in the book.
Take the names given in the text to each of the herbal prescriptions – whilst imaginative, these tiresomely err on the florid new-age side – names like Kissable Lips Potion, Temple Gates Tea, and Ageless Beauty Beverage put Celestial Seasonings marketing department to shame….whilst others such as Herbal 911 suggest that inspiration was not always up to the task…..my personal favourite is Slow Flow Go (good name for a guy remedy too). On balance such names are probably distracting, it would be clearer to describe the remedies simply in terms of what they do. Prescriptions don’t really need names.
Another perhaps culturally characteristic aspect is the consistent perspective of self-help which pervades the book, to the detriment perhaps of precise definition of the role of practitioner in the healthcare process. The omission cannot altogether be explained on the grounds that herbalism is not legally recognised as a profession in the US as it is say in the UK. The question of the role of the practitioner in the self-help healthcare movement is one which needs clarification, especially in the US where there is a bewildering variety of both lay and professional practitioners.
For example there is a real question as to correct diagnosing of the onset of menopause itself – it can be misdiagnosed because many of the symptoms associated with menopause occur in other conditions, not only gynaecological, some of which may have serious implications. Irregularities of the menstrual cycle can occur in diverse conditions ranging from leukaemia and Hodgkin’s disease through to thyroid disorders and pituitary tumours. Intermittent bleeding can be a particularly ominous symptom, indicating uterine adenocarcinoma as well as various benign growths. Palpitations can indicate pathological arrythmias, hot flushes can occur in phaeochromocytoma, thyroid storm, autonomic neuropathies and so on. Not to labour the point, but there is an a need to have any such symptoms investigated by an experienced practitioner to confirm that menopause is indeed what’s happening.
Of course, Amanda McQuade Crawford did not set out to write a textbook of gynaecological natural medicine, although there certainly is a need for such a work. But the role of the practitioner must include guidance about when consultation is appropriate. And indeed, the author does make references at several points to the need to consult healthcare providers – rather than describing possible alternative diagnoses or evaluating different investigative techniques in detail in the text. The model she implies is that a practitioner is necessary to facilitate informed selection of investigative or therapeutic strategies by clients to help them attain their health goals – but she adds that these decisions are ultimately the responsibility of the individual. This is clearly a counterposition to the traditional medical model, more relaxed than the naturopathic model, and more sensible than the Wiccan or new-age versions.
In menopause, an informed opinion is particularly relevant to the HRTdebate, and the related questions about cardiovascular disease and osteoporosis. The Herbal Menopause Book includes a chapter devoted entirely to this subject. A welcome feature of this chapter is the very clear assertion by the author that human steroidal hormones are not synthesised in the body from plant “precursors” – an enduring myth that has fuelled much of the confusion around Disocorea, so called Natural Progesterone products and so on. Given the considerable general confusion on this area it is really rather important that herbalists do everything they can to be as clear and precise as possible on these matters.
SOME GUY TYPE COMMENTS
Amanda McQuade Crawford does make a few errors in the section on phytoestrogens. She refers to plant constituents with hormone like effects in humans as plant hormones – which hardly helps the terminological confusion in this area – plant hormones are entirely different entities that make roots grow downwards, shoots grow upwards and so on. In classifying the various phytoestrogens she describes the ginsenosides as sterols, they are actually steroidal triterpenoids of the dammarane type. Her discussion of essential oils is full of mistakes – volatile oils are not at all related to sex hormones, they are not extracted from plant fibre or chlorophyll (but mostly from flowers), and are not formed from cholesterol (but from isoprenoid subunits derived from the mevalonic acid pathway and are mostly mono- di- and sesquiterpene hydrocarbons and their derivatives) The remark about plant oils being cholesterol free is gratuitous – plant oils are fixed oils (fats) and unrelated entirely to the volatile oils or terpenoid compounds. Possibly, essential oils should have been discussed in a separate section – they are sufficiently different from herbs to merit special treatment. For example a questionable suggestion by the author in another chapter is the incorporation of essential oils into lubricating salves – most authorities on aromatherapy point out that if safe sex is being practised no essential oils should be used since these can cause chemical damage to condoms.
An excellent discussion is given in this chapter to the practical problem of coming off HRT, and an original and useful sequential program of herbal prescriptions is given for progressively weaning women away from physiological “dependence” on HRT. The only shortcoming here is the omision of any discussion of the temporary use of quasi – natural progesterone, (ie progesterone identical in structure to endogenous pregesterone rather than synthetic progestins such as medroxyprogesterone). This is perhaps one of the more useful applications of “natural progesterone” therapy.
The risk of osteoporosis forms a major part of any woman’s consideration of menopausal strategies. One of the major myths of menopause perpepetuated by the manufacturers of HRT pharmaceuticals is that osteoporosis is caused by oestrogen deficiency. This is incorrect – it is part of the general aging process, which certainly can be accelerated for a time during and after menopause. But the physiopathology of the process is not explained clearly enough in the text: in describing the yin-yang dyad of bone builder-demolition cells for example, the author suggests that oestrogen does actually stimulate osteoblasts ( which is exactly what HRT marketers would like people to believe) but in fact it is even recognised by conventional medical authorities that oestrogen actually only inhibits osteoclasts, it thus can slow down bone resorption but does not itself add to bone density; progesterone however does stimulate osteoblasts and can alone reverse bone density loss in the absence of exogenous oestrogen. This again is an instance where the possible of use natural progesterone should be discussed more fully.
Finally, Amanda McQuade Crawford tends, like most decent herbalists, to emphasise supplements less than appropriate nutritional measures. The discussion of calcium supplementation in relation to osteoprosis should however consider the importance of magnesium in more detail. Magnesium is a cofactor not only in calcium metabolism and bone formation, but is a key cardiovascular protective agent, is neuroprotective and a crucial cofactor in dozens of vital reactions particularly related to energy production and essential fatty acid metabolism – it warrants more attention from herbalists in general given the fact that an estimated 25% of the population may be magnesium deficient, and certainly it is a problem that increases with age. Some practitioners aware of this recommend increasing the Cal-Mag ratio from the standard 2:1 as recommended in this text to 1:1 or more depending on the individual clinical magnesium status.
PUBLISHERS – A RANT
More guy type comments…to anyone with a passing familiarity with graphics it is clear that the publishers have done a wretched typesetting and design job on this book. Here is a book designed to inform, it is packed with useful information – explicitly intended as an instruction manual not a coffee table adornement. How unfortunate then that Crossing Press appear to have farmed out the typesetting and design to a part-time/amateur using an early version of MacWrite or similar elementary word processor. The type is set without adequate leading, the measure is too wide for legibility, the white space is non-existent and the use of a single type face throughout is visually congestive. The text is devoid of illustrations, and graphic embellishment is confined to a single clip art decorative rule. The whole thing is thus made unnecessarily hard to read and navigate around. Similarly, one could question the capability of the series editor – or even whether there is one at all – the text would have benefitted from some careful and sympathetic editing and re-organisation to increase the accessibility of information and eliminate some repetitiveness.
Warming to theme of publishers one also wonders to what extent they insist on entitling their books according to their own myopic marketing criteria without regard for facts – the title, The Herbal Menopause Book , does tend to suggest that this is either the only, or at least the definitive book on the subject, a point quite reasonably disclaimed by the author in her introduction – after all Susun Weed published The Menopausal Years some time ago, and there are plenty of popular books on herbalism directed specifically towards women.
The book is not really directed at practitioners as such, but it would be a useful addition to the library of any herbalist who likes to collect recipes. It is already very popular among practitioners however – currently ranking fourth in the Bookworm’s famous Recent Title Top Ten Charts. Perhaps this is because Amanda McQuade Crawford is a herbalists herbalist – in this book she has given us an accomplished lesson in how to write from the heart, placing medicinal herbs at centre stage, whilst providing sensible information to empower her chosen audience.
The Herbal Menopause Book is published by Crossing Press, Freedom, California (1996) ISBN 0-89594-799-4, price $16.95
Amanda McQuade Crawford has ten years experience as a professional medical herbalist in the United States and Great Britain. Originally educated at Vassar, she graduated from the UK School of Phytotherapy and is a member of the NIMH(UK) and the AHG. She has studied and taught traditional healing using medicinal plants in Asia, South America, Australia and many regions of North America. She is co-founder and Dean of Phytotherapy of the National College of Phytotherapy in Albuquerque, New Mexico. She lives and practices in Ojai, Southern California.