If your house was on fire, you would run away. But the body, impossible to escape, is a different matter. Waking at three in the morning, Darcey Steinke, an American writer who is in her 50s, experiences a tremendous blaze. It begins in her stomach, bowls along her nerves, courses behind her face and finally radiates from the top of her head. Fierce and raging, it makes her want to burst out of her own skin: up and away like a rocket, through the roof and into the cool air beyond. What to do? Downstairs, she presses the improvised fire extinguisher that is a bag of frozen peas hard to her chest.

Steinke’s Flash Count Diary, in which she hopes to tell “a new story” about the menopause, began its life as a scribbled record of these internal weather fronts, the flames of which lash her 10 times a day. Such flashes – we call them hot flushes, but I rather like the American version, suggestive as it is of drama rather than embarrassment – are thought to be connected to a drop in the body’s production of oestrogen, though in truth medicine is not entirely certain of their cause: levels of the hormone have been found to be roughly the same in both those who suffer from flashes and those who don’t.

What can be done to prevent them? This, too, is moot. Some put their faith in wild yam or vitamin E. Belinda Carlisle, the singer from the Go-Go’s, favours keeping a magnet in your knickers. But if you can’t (or don’t want) to butch it out, hormone replacement therapy (HRT) is the standard treatment.

Steinke is determined to butch things out, at least in a medical sense. Like Germaine Greer before her, she regards HRT as an instrument of the patriarchy, which requires women neither to fall prey to the mood swings that can accompany the menopause nor to allow their vaginas to become too insufficiently pliable for sex. Personally, I think this is a depressingly retrograde argument, and a pretty stupid one, too. You might as well describe the pill, which also fiddles helpfully with a woman’s hormones, as an instrument of the patriarchy. Even if HRT carries with it certain risks, it isn’t remotely on a par with the unnecessary, rip-off vaginal rejuvenation laser treatments about which Steinke hears, to her disgust, at a conference in Amsterdam. Asking your doctor about it is no more a matter for shame, feminist or otherwise, than asking about antidepressants.

Nevertheless, I found myself oddly compelled by this weird, infuriating, uncategorisable book (it sells itself as memoir, but thanks to its fragmentary style and abundant use of quotations, what it most resembles is a commonplace book). I enjoyed arguing with it – and, no, such pugnaciousness has nothing to do with my age, which is 49. I long to read something that deeply examines the vicissitudes, mental and physical, that accompany this stage of my life – and yet so few writers hit the mark.

No one wants a load of inspirational guff about moisturiser and seizing the day; you’d have to be blind not to see all the ways in which older women are disregarded by society. But it’s important, too, to remember that not all women experience this time in the same way. Not everyone is as miserable – or even as sweaty – as Steinke.

Is it, as she suggests, really the case that in menopause, women are “not only invisible, but despised”? Her feelings of loss seemed to me to be so extreme I began to wonder whether she hadn’t simply internalised some of the attitudes (to do with female youthfulness and pulchritude) that she most purports to despise. Nor could I fully identify with those few aspects of her age that she seems to want to celebrate: the diminishing of her desire, for instance, or her “bright, ascendant rage”. Where she is depleted, I feel only a rising energy. Where she is angry, I have only a greater sense of clarity when it comes to what I think and feel.

She develops a fascination with whales, the female of which species has a long and productive post-menopausal life (older females lead their pods) – and eventually, off the coast of Washington state, she looks a century-old orca known as Granny straight in the eye. I loved this section of her book, for its wonder and its sense of inquiry, but there is something muddle-headed, for me, in the way she seeks kinship in animals. Is the captivity of Lolita, a killer whale that has been kept in a pen by the Miami Seaquarium since 1970, really akin, even metaphorically speaking, to her own situation? Does the loss of a woman’s fertility really shrink her world to such a degree? Surely the sane answer to both these questions is: no.

Steinke also finds solidarity with transitioning men and women (interestingly, she has no problem at all with the fact that they take hormones). Though her menopause has enabled her to slip out from under a “claustrophobic femininity”, she is not, she writes, “fully masculine” either. She feels “in the middle, a third sex”. Again, I found this, to put it mildly, provocative. Is her notion of masculine and feminine really so fixed? Does a face that is more lined than it used to be really mean that one belongs to a third sex?

None of my female friends and contemporaries was labouring, a decade ago, under a “claustrophobic femininity” and none of them would now describe themselves as being in a process of “un-gendering”. Most are far better able to express their femininity (whatever that means to them) than when they were younger, just as they’re far better able to express their sexuality.

I will say it again: Flash Count Diary is a book you want to argue with and herein lies both its weakness and its strength. It moved me, if not to bright, ascendant rage, then certainly to exasperation. But talk back to it and you may feel (I hope this doesn’t count as inspirational guff) emboldened: more powerful and even, perhaps, more beautiful.

After all, at least you’re not Steinke who, for all her merciless honesty, seems to me to bring a certain self-loathing to the table. Like some strange feminist penitent, even as she rails against women’s suffering, she seems to be determined to suffer herself for as long as the fires last.

• Flash Count Diary: A New Story About the Menopause by Darcey Steinke is published by Canongate (£16.99). To order a copy go to guardianbookshop.comor call 0330 333 6846. Free UK p&p over £15, online orders only. Phone orders min p&p of £1.99