For what it's worth, I've been using combo of ovestin & vagifem for 5 years now, following significant UTI problems, with VA; internal scarring from childbirth added to the problems of pain and infections.
During first year of topical, targeted HRT gels/ creams, use & following Fenton surgery to correct scar tissue everything was massively inflamed. I needed antibiotics to clear vaginal infection caused by scar tissue. Using ovestin at this point was very difficult as the tissue was fragile and it caused burning sensations. The gynaecologist mentioned that there's an antiseptic element to ovestin cream. However, he did say to treat fragile tissue, it was by far the most effective option. He then prescribed less astringent vagifem , which I persevere with and eventually things settled down. At that point, I was able to use both - vagifem for higher up, ovestin lower down.
Five years down the line, I tend to favour ovestin as vagifem gel tends to dry up on me. Ovestin as a cream for me works in a more lubricative way. I'm used to the cream now, applying about twice - three times a week. If I use too much of it, it can irritate the urethral area.
However, I have found HRT cream / gels a complete godsend and haven't looked back since 2014. You might find it useful to read my early posts on this website to see how far I've come since then. It offers hope for all of us. I rarely get urinary tract sensations, last infection dates back to 2015. I think it's important to persevere with topical HRT if it's been prescribed for a condition, but take your time, listen to your symptoms, be kind to yourself, and be flexible in your approach with ovestin or vagifem. Good luck !