I just thought I would mention this here as there is talk of exercise in the thread.
I had come to the conclusion that Vagifem had stopped working because a flare up was lasting too long but it coincided with what I now know is sciatica, the first time I have ever suffered with it. Because of where the nerve is situated it of course affected the whole surrounding area making anyone who suffers with Vaginal Atrophy sciatica will make the condition worse. The only thing that helped me was to increase my Vagifem dose to two a day and that gave me instant relief.
The sciatica is now calming down as is the VA symptoms and I am back to my usual one a day but I thought I would mention it, perhaps an exercise that includes the piriformis muscle might be a good preventative measure for the future for anyone with VA.