Hi Carnation
Please don't apologise - your post is just right, and anyway they can always be moved if really in the wrong place!!
As to your question - yes you're quite right - many women find that local oestrogen is not sufficient to control VA (Vaginal Atrophy and all that entails
) and need systemic HRT as well.
CLKD that is incorrect - it does matter where you are in menopause - oestrogen levels fluctuate dramatically and then start to decline overall during peri-menopause and once you reach menopause oestrogen levels continue to drop pretty fast over the next two years and then sort of level out. Some women only start to experience VA at this point, and others find, as you have that you needed more than Ovestin to keep VA at bay now that you are post menopause.
If you're wanting to have a continuous combined HRT and happy with oral preparations ( you haven't said how old you are?) then Femoston is one of the better tolerated pills. Always better to have at least a low dose rather than ultra-low so the 1/5 would be a good one. However Kliofem contains 2 mg oestrogen ( not sure which Elleste Duet you were taking - there used to be a 1 mg version but if you were on the 2 mg one that would be the same as Kliofem) and that being the case the Femoston would be lower. Patches are not strictly comparable but Evorel conti is medium dose and depending on absorption you may achieve the same relief of symptoms as with the 2 mg tablets.
Another possible reason for your problems with some HRT types is because they are continuous combined which means taking a progestogen every day. Some women get side effects which can differ with the different types. A good option is to start with a similar one but on a cyclical basis to see how well you tolerate it and then if you're fine go onto the conti version. However this does mean you would get a withdrawal bleed!
No-one should need to take pain relief to treat symptoms of VA - as this means that dosing and treatment are not right. Ovestin is not a soothing ointment to be taken afternoon and evening - it would not work that quickly except as an ointment or moisturiser in which case best to use another product designed for this purpose. The oestrogen takes a while to achieve maturation of the tissues ( "plumping up").
Carnation there are lots of threads and posts on VA - look at Maryjane's and some of Dancingirl's posts and the long-running thread in Private Lives started by Dancinggirl "The Burning Club" which have some great advice.
Do let us know what you decide and how you get on.
Hurdity x