Oh my! I had a totally unnecessary hysterectomy as well as oophorectomy / ovary removal and the effects have been beyond devastating. I have since learned that ~90% of these surgeries are unwarranted and that we need our uterus and ovaries our whole lives. I see some red flags with these doctors but not with your u/s report (findings look normal). Unfortunately, hysterectomy is so lucrative for doctors and hospitals so it is heavily "marketed."
First, yes, since you have your uterus, you should not take estrogen (E) without progesterone or a progestin (P). That being said, a short course of E without P should not be harmful. It is possible that your regular (female) gyn just wanted to see if Premarin helped your menopausal symptoms and was maybe then going to add in P or Rx a combination E/P hormone therapy to address your menopausal symptoms while also protecting your uterine lining.
It is not surprising that the Premarin caused a bleeding episode since E causes the lining to thicken. Better to shed than not as the thicker the lining, the more chance of abnormal cells developing. But a lining under 5cm after menopause is considered good (and yours is 4cm). If you stopped taking the 10 day course of Provera that may have also triggered a bleed (that is what it is supposed to do). Taking P continuously keeps the lining thin usually without a bleed (although some women do get some spotting with P and may need to try other forms or dosages or switch to monthly or quarterly cycled to have a "planned" bleed). However, your lining is nice and thin already at .4cm which makes you low risk for endometrial hyperplasia and uterine / endometrial cancer. And just to help ease your mind, if you would have abnormal cells (endometrial hyperplasia), it can take years for it to develop into cancer.
As far as the fibroids, they are extremely common and typically do not require any intervention. And yours are tiny so I wouldn't see why they would need to be addressed.
Did you end up having the endometrial biopsy? That even seems a little overkill but at least it is an in-office fairly easy procedure.
Keep us posted.
Did not think to ask about the prolapse. Since you have had this for awhile, is it not bothering you much? If it is, you could pursue having a pessary inserted. There are many different types and you have to be properly fitted for one. I know many gyns push surgery for prolapse because it is much more lucrative than "prescribing" a pessary so it can be difficult finding a doctor to fit you for a pessary.
There are a couple of problems with surgery for prolapse. For one, they have a fairly high failure rate. You may get relief in the short-term but then the problems may return. And those surgeries seem fairly risky. But even worse, many gyns do a hysterectomy for prolapse and having the uterus removed increases your risk of (another) prolapse not to mention all the other nasty after effects of hysterectomy (with or without ovary / gonad removal). I will be happy to expand on these effects if you want. Hope this helps!
Bleeding in the early post-menopausal years is actually not that uncommon, regardless if one is taking HRT. That is because the ovaries can have some periods of increased hormone activity causing the lining to build up which it then sheds to keep it thinned out. The ovaries produce hormones our whole lives; they just gradually shift from their reproductive role to their endocrine role after menopause. These hormones are necessary to keep every cell in our bodies healthy. Yet over half of women's ovaries are needlessly removed during hysterectomy, another destructive surgery. Oftentimes, testing (e.g., u/s and/or biopsy) for post-meno bleeding determines that there is nothing wrong and it is chalked up to this sporadic ovarian activity. "Just being cautious" is not a good reason to do a hysterectomy if there is no evidence of cancer or severe hyperplasia. A thin lining like yours (.4cm) is low risk for hyperplasia or cancer to develop.
Did you know that only about 10% of hysterectomies are done for a cancer diagnosis making most of the remaining 90% unnecessary? Gynecologic cancers are rare. A U.S. woman's lifetime risk of endometrial / uterine cancer is less than 3%. Ovarian and cervical are more rare than that. Yet 40-45% of women end up having a hysterectomy because it is marketed as having no negative effects and many gynecologists use cancer or other scare tactics to get women to consent to them. There are many women's stories in articles and associated comments on Hormones Matter. You can do a search for "hysterectomy" on the site to bring up all the articles. The HERS Foundation is another good source of information on the many negative effects of uterus removal. Removal of the ovaries has a whole other set of problems.
Hysterectomy destroys the anatomy because it causes the bladder and bowel to drop which can lead to dysfunction such as incomplete emptying, incontinence, fistula, cystocele, rectocele, enterocele, urethrocele. It destroys our figures because the ligaments they cut to remove the uterus are the pelvis' support structures. They keep the spine, hips and rib cage where they belong. That all gradually collapses after hysterectomy. That is why women who have had hysterectomies have shorter, thicker midsections, big bellies and no curve in their lower backs. This is bad enough for our self esteem but it also leads to chronic back and hip problems and reduced mobility especially in the long-term. The changes to my figure started becoming evident between 1 and 2 years post-op and now, 13 years post-op, I am experiencing some of the back and hip pain and problems.
Many women report a loss of libido and sexual sensation after hysterectomy. That is not surprising since you are losing a sex organ (the uterus) and they sever a lot of nerves and blood vessels. Those who had uterine orgasms will never have them again. And other orgasms pale in comparison. I experienced all of these losses as well as a loss of maternal feelings.
Studies show that hysterectomy without ovary removal increases risk for a number of health problems including heart disease (#1 killer of women), metabolic syndrome, and some cancers (thyroid, renal cell, rectal, brain).
The ovaries usually do not function normally after hysterectomy since there is a loss of blood flow and feedback with the uterus. Sometimes they shut down completely as if they were removed. Numerous medical studies show accelerated aging and an increased risk for many health problems after ovary removal which would also apply to ovarian failure. These include heart disease, stroke, dementia, parkinsonism, impaired cognition and memory, sleep disorders, mood disorders (depression, irritability, anxiety, mood swings), vision and skin deterioration, sexual dysfunction, more severe hot flushes. Overy.org is helpful and links to a list of studies.
Women are told they can take hormones after hysterectomy and/or oophorectomy but no cocktail of hormones can replace what the ovaries produce on their own and in just the right amounts for her body, "bio-identical" or not. I can attest to that. I was started on a "therapeutic" dose of estrogen shortly post-op yet I aged 15 years in just 4 months' time including losing 75% of my hair which has never stopped falling out (and I am 13 years post-hysterectomy). The front section of my hair turned gray... I NEVER could have imagined that hair could gray overnight! I lost a LOT of skin collagen so my skin sagged and wrinkled... again all within 4 months of surgery. I also could barely function - could not fall asleep or stay asleep, could not think straight (feared losing my job), could not remember what I did 15 minutes ago much less a day or week ago, everything (big and small) became overwhelming, bills got overlooked, lost the loving feelings for my husband and children, became SEVERELY depressed and overcome by anxiety. I became a recluse and when I did leave the house aside from going to work, I avoided people because I had aged so much. Thankfully, my husband took on a lot of the household and kid stuff.
I hope this helps you understand how important our sex organs are! They are for MUCH MORE than reproduction!
Another good resource - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3804006/.