I've been using a combination of vagifem & ovestin with reasonable success for over 3 years due to VA and earlier bladder/ urethral problems ( now thankfully more or less resolved ).
Why docs still raise eyebrows over long term prescribing of decent quantities of topical oestrogen is beyond me. A letter from a good gynae will resolve this potential issue very quickly - as happened in my case. I think there is no ' average ' amount here. Each person is an individual. Some women only need vagifem once a month/ fornight/ week, while others like myself - with severe VA - need reloading several times a week from time to time. The indicators for reloading for me are urethral soreness, dryness and vaginal discomfort. Like one or two other ladies on this forum, I use ovestin cream ( large pea- sized blob ) for ' just inside ' ( scar tissue ) & a smear on the outside - no more. This is done about twice a week on a normal basis and I usually alternate with two gel pessaries. Sometimes I apply a small blob of ovestin lower down together with a vagifem pessary higher up. The gynae I saw for Fentons surgery ( scar correction ) recommended that ovestin lower down in my case was an essential part of the treatment - as to quote ' Vagifem doesn't always trickle downwards sufficiently with some women who have VA '.
My VA has vastly improved during three years' treatment - but I always remain on guard and realise this is a for life approach. The stinging I experienced during the first six months if so made me almost give up - but I persevered and I now rarely experience stinging/ burning issues. The strategy I used during these episodes was a softly, softly approach - using a combination of vaginal moisturisers with intermittent vagifem ( which I found more comfortable than a slightly higher concentrated ovestin cream ). I guess some of the discomfort we experience is due to fragile tissues down there. All the more reason to seek help and treatment when VA first starts to present as a problem.
The main thing, everyone is different, so treatment and doseage has to suit the individual - and it often takes more than a year for things to settle down and for some sort of pattern to establish.
