The initial 2-3week load up is designed to build up the wall of the vagina so there will be virtually no systemic absorption after that. Feeling bloated, stomach cramps, even some slight spotting is quite normal at first. I found the fillers of Vagifem, Ovestin and Gynest really irritated things, so I now use the Estring. When treating vaginal atrophy and bladder issues it can take time for it to work. I was getting particularly problems with burning and it took over 6 months before things improved.
So my message is - be patient. The low dose Vagifem, which is now standard, is often too low for many women and they have to use it 2-4 times a week to keep things healthy around the lady bits.
PaulineW - the instructions say every night for the first 2 weeks so it's important to follow this.
Hyacinth - I expect the bloating will settle down once you've finished the 2 week load.
Good luck ladies - keep us posted about your progress. DG x