Hi PattyRh!
I hope your scan rules out anything concerning and you're able to resume vaginal estrogen.
Regardless of whether you choose to use Ovestin cream or Vagifem pessaries or both, you may want to ensure that you place the estrogen in the lower-third of the vagina, rather than pushing it up as far as it will go. That's not necessary. In fact, it's not desirable in post-menopausal women.
“First uterine pass effect” means that more estrogen will reach the uterus if estrogen is placed in the upper third of the vagina.
"The study demonstrated that the vagina to uterus preferential distribution of E2 takes place if E2 tablets [ie Vagifem] are placed in the upper third of the vagina but not in the lower third. Therefore, for improving endometrial maturation in premenopausal women, vaginal E2 tablets should be placed in the upper third of the vagina; whereas for treating postmenopausal vaginal atrophy, E2 tablets should be placed in the lower third of the vagina to minimize the risk of endometrial hyperplasia."
If you're using Ovestin internally, it's not necessary to use the applicator. I'll post a link to instructions with diagram, as well as copy them here:
How do I apply vaginal estrogen cream with my finger?
1. Wash your hands with soap and warm water.
2. Remove the cap from the tube and apply a pea-sized amount of cream onto your finger (enough to cover atleast ½ of your index finger).
3. Find the vaginal opening. Immediately above the vaginal opening is the urethra (a small opening where urine comes out when you urinate). The urethra may not be as easy to identify as the vagina because the opening is much smaller; however, use the diagram to determine its approximate location.
4. Spread the cream into the vaginal/urethral area. As the cream is spread, make sure to cover the urethral opening and just inside the vagina as this is where most estrogen receptors are located. It is not necessary to push the cream high into the vagina.
5. Wash hands with soap and warm water.
Vaginal Estrogen: Information and Instructions
https://www.med.umich.edu/1libr/urology/EstrogenVaginalCream.pdfWhile you're applying the cream, ensure you also apply some to the labia. Low estrogen level, chronic irritation, and inflammation can cause labial adhesions/fusion. The clitoral hood can also develop adhesions. Spread that cream around!
Keep us posted on your scan results.