So. Not sure if this is the place to ask this, but what the heck.

I'm late 40s. I was dx'ed with PCOS and infertility a loooong time ago. Very cystic ovaries, occasional ruptures. I treated it for years via different methods, then other health problems occurred and treatment went by the wayside.

Fast-forward to the last several months. I was released from the hospital in April 2022 after a near-fatal illness. Did not menstruate for months as a result of that illness, but once I was discharged, I resumed menstruating. Light, 2 - 3 days, minimal cramping. No problem.

Then last month, things went completely haywire. I had a mostly normal menstrual cycle just after Thanksgiving. A week later, I woke up covered in blood, minimal cramping. I bled for a day or two, stopped. Went to the gyno, who said it might have been a ruptured cyst, she couldn't really tell. However, she confirmed I'm perimenopausal and suggested inserting an IUD instead of HRT. Me, I wanted to remove the faulty plumbing, but she gave me a spiel about how insurance doesn't like to authorize full hysterectomy. FL gyno didn't want to do it either, for reference, despite all of my issues.

Told her I'd think about it, went home. As expected, I started to bleed after the exam, didn't think anything about it for a day or two... then the flow turned extremely heavy, with clotting, debilitating cramps, and went on for two weeks. I called the gyno, who wanted to see me but said she couldn't until January 13. Yeeeeah, not an option (Gyno is in NC, I go back and forth between FL and NC regularly, was headed back to FL on 12/29). Thankfully, flow stopped the day before Christmas Eve.

I haven't bled since, thankfully, but am wondering - aside from very likely being hormonally out of whack thanks to a series of UTIs/kidney infection/sepsis/raging blood infection and the assorted medications to help me recover - should I consider HRT or continue pushing for removal? Any counsel is appreciated, thank you!