Worrypot60 - oestrogen deficiency carries on doing its worst as we age. The bladder has oestrogen receptors and as our oestrogen levels drop the bladder function deteriorates and brings UTI type symptoms, loss of bladder control and general discomfort; oestrogen helps to keep the bladder working well. However Vagifem is a very low dose so will only do so much. Yes, you will need to use Vagifem for the rest of your life but as you have had a hysterectomy and you are only 60, then I would suggest some systemic oestrogen alongside the Vagifem might get things more under control. Unless you have a medical condition that prevents your using systemic oestrogen, I would ask your doctor to have either Oestrogel or oestrogen patches (Estradot are the best) to see if it improves things.
Oestrogen alone brings very few risks, if any, so can in theory be used long term provided you don't develop health problems that prevent this. It tends to be the combined HRT with progesterone that carries some small risks past the age of 60.
Do use vaginal moisturisers as well e.g. The YES products or SYLK. I also find Multi Gyn Actigel can sooth and treat burning and discomfort if I'm itching or sore. You can get all these things online. DG x