I am afraid a lot of General gynaes are not at all knowledgeable about HRT , mad but anyway.
I am on oestrogel 1 pump a night this is low dose , I use 100mg utrogestin for 10 days a month ( may change to mirena coil ) I also have the estring in place , and if I want to I can also use estriol or ovestin on the outer bits , I don't as they irritate more.
You could use vagifem 5 plus days a week if neeeded , plus ovestin or estriol for the outer bits.
Or you could use ovestin internally and externally/ or estriol internally and externally.
I no of ladies who have to use 2 vagifem 5/7 days a week.
No shoe fits all , and what suits one doesn't another , It's trial and error and that goes with specialists I am afraid .