I just have to say that I really admire the great advice on this thread. I have many times considered how much easier it would be to not have a uterus so as to avoid the progesterone piece of HRT since I am intolerant as well. However, I don't think most doctors will even consider it unless there are clinical indications for the hysterectomy (i.e. firbroids, adenomyoma, severe endometriosis or other concerns.) It is a major op and hard to tell how one will adjust afterwards. Most women I know who have had hysterectomies have felt fantastic but they were having them for very vexing issues such as severe and intractable bleeding, growing embedded fibroids, etc.
Hurdity, the ablation is a thermal or laser destruction of the endometrium. It is much more permanent than a D&C. I'm not sure if the destruction is utter and total to the degree that no progresterone would be needed. But it's an excellent question and one that I'd like to know the answer to as well!
Can I just say, as an aside, that I am continually impressed by the level of care, concern and knowledge that longer time members bring to those of us new to the forum? It is a lovely thing to witness and I (for one) am most appreciative. As others have mentioned here, and in other posts, it is so often the progesterone component that causes side-effects with women using HRT. The idea of less frequent use (regimen mentioned by Hurdity) is something to consider, under the knowledge and approval of a qualified practitioner.
I do 10-days/month of 200mg Utrogestan and I don't even get a bleed. But I'm on a very low dose estradiol (0.025 patch as of now) and believe I am not even building up enough lining to shed. Perhaps this also because I believe I am post now and my own hormones have stopped 'interjecting' here and there.
A thought on this: the higher risk mentioned earlier in the thread would be estradiol-dose dependent, wouldn't it? Someone using a 1.0 or 0.075 patch (considered relatively high dose) will likely build up far more endometrial tissue than a woman using a 0.0375 or 0.025 patch. I don't think there are 'absolutes' when it comes to 'increased risk'. I would imagine individual absorption rate affects how much the lining responds to a given dose of estradiol. Additionally if in peri and your own estradiol is still kicking in, this complicates the picture a bit. It really boils down to your own physiology and how your body responds to your dose of estradiol.
There must be a workable solution short of hysterectomy and I do hope you find one peacegirl! Good luck!