What do you counsel her?
A) To have a hysterectomy and take estrogens without a progestin.
Sorry
The hysterectomy will certainly eliminate the unscheduled bleeding and allow the patient to take estrogen alone without progestins which usually cause the side effects associated with HRT. However, the patient has no uterine pathology to warrant a major operation. The bleeding is iatrogenic. Stopping the HRT will most likely stop the bleeding.