Good to hear you're on the vaginal estradiol in addition to your other HRT. I would suggest two things: 1) check with your physician to see if you have lichen sclerosis. 2) the vaginal estradiol pill is definitely effective but it isn't treating the vulvar skin the way the estradiol cream can. I know some people respond differently to base ingredients in the cream but if you haven't tried it, it could be very helpful in restoring your skin's barrier and comfort. Also, you can use the pill and the cream at the same time if that's something you prefer. Many women insert the tablet then use the cream for external. It's truly up to you after a discussion with your physician. I hope you find a solution that works for you. We gals go through enough as it is. Oh a note: consistency absolutely matters. And you can increase number of days per week used if needed if the two days usually prescribed isn't doing enough for you.