Just a thoguht mollie2 - when you say that you get swelling, what is actually swelling? It could be the oestrogen waking up the areas that need the oestrogen and could actually be a good thing??!!
If the Vagifem is giving relief then with regular use it might be doing the trick. Do remember you need to use it initially fro 14 days and then a minimum of twice a week fro it to be effective.
Do you use a vaginal moisturiser like Sylk, Replens, Hyolafmme or Multi Gyn Actigel? - most of us who suffer with VA find we need to use one or more of these together with Vagifem to keep things comfortable - it's trial and error fixing one that works for you.
If your burning is centred around the urethra (as mine is) then drinking plenty of water avoiding caffein and fruit juices is essential - anything that is acidic - and making sure the vaginal flora is balanced by using the moisturisers. Also make sure you empty your bladder properly every time - when we are in pain in that area we tend to clench which stop the natural flow of urine and then we often retain some urine which will then cause irritation. Hope that helps DG x