I saw my GP last week and she had been on a course with the British Menopause Society recently. She said the consensus there was that they are under-dosing Vagifem. I thought I had a UTI and, while she took a urine sample to check, she suggested I up the dose from twice a week to 3-4 times a week or take two pessaries twice a week. It turns out I didn't have a UTI, it was my VA playing up. So I now take Vagifem every other day.