Hi Annemaria
Symptoms should start to ease within days as CLKD says but if VA is severe then some women need to use it daily for longer than the 2 weeks "loading" period. Remember that the dose of Vagifem now is only 10 mcg whereas in the past there was a higher dose of 25 mcg for women for whom 10 mcg was insufficient. Since this was discontinued a couple of years ago, some women are prescribe more by their GP. Maybe try the "re-load " for longer? You should have seen an improvement by now. Other options include the Estring which delivers approx the same dose as the Vagifem 25 mcg.
Also several women do need systemic HRT as well as local oestrogen to properly keep VA at bay - you won't know if you are one of them until a few weeks have passed. I was the other way round - I started with vaginal oestrogen, progressed to full HRT ( for menopausal symptoms), stopped the local oestrogen - but then found that full HRT was not sufficient to deal with VA so started that as well. ( all this started age 52/53 ish). I am still on both at age 63.
Hurdity x