After 5 years on Vagifem and Ovestin my flare ups are now only very occasional and sorted quickly with Dermovate cream. When they do occur its usually an external factor as I never change my dosage or routine (5 a week vagifem and Ovestin externally every night, use Ovestin internal on the 2 days I dont use Vagifem).
I now know my triggers, the worst is stress. Also I'm always better during the summer months getting the sun, so now take vitimin D during the winter, I'm sure this has helped. Not drinking enough and getting dehydrated can cause a mini blip.
Lockdown for 10 weeks meant I wasn't sat at my office chair 8 hours a day, (laptop on the sofa instead) very little work stress, breaks whenever, sat in the sun, I've felt completely normal for the first time in 5 years and actually forgot I had VA (not usually possible as never 100%).
Ive decided to retire a couple of years earlier than planned, lifes too short.