Obviously I'm not able to compare with hormonal treatments having never used them but, in my experience, Replens and Yes applicators have helped enormously with VA and I've never had a UTI or any urinary discomfort or issues so I assume they're helping on that front too.
I use either a Replens or a Yes applicator 5 days out of 7, small splodge of Epimax externally first thing in the morning and last thing at night. Sylk for intimacy. This regime works for me. I'm glad it's all obtainable on NHS prescription or I'd be spending a fortune!
I received lots of good advice and support from my GP (MRCOG) who also referred me on to gynae consultant and specialist nurse (partly because GP was unable to obtain satisfactory cervical smear). Hospital staff also very good with practical suggestions and great attitude as regards how upsetting VA can be.