@kathleen1314 Thank you! The 6.5mg Intrarosa dose was way too high for me.

I'm 49 now but started experiencing signs of GSM at 47. My urologist put me on Vagifem which helped for five months. I had already had painful periods since my 20s which were making me homebound by my 40s.
In my 20s, I was diagnosed with IC. In my 40s, fibromyalgia and vulvodynia were added to my list. I've been sensitive to ingredients in shampoos, detergents, etc., since my 20s. I was recently re-patch tested showing similar sensitivities plus a new allergy to Monistat.

I switched to a menopause/hormone specialist farther away after when Vagifem failed me plus I was also developing headaches, losing hair, nails were breaking, my vagina was dry again and now crampy and my cycles had gone from debilitating for one week to debilitating for most of the month. Imvexxy helped for five months with a little topical compounded Estradiol. My existing obgyn was of little help except to say she thought I'd been living with endometriosis since my 20s and if I'd lived with it that long then I could until menopause. She lost interest. But thankfully she had someone on staff to do bladder instillations, which helped me on bad days.

I switched to a new gynecologist a year ago who saw the severity of my pain and after trialing two other meds my uterus ( a feeling for about two years) continued to feel like it would prolapse even though he and my pelvic floor PT said it would not. I did my exercises and wore a belly band. I was beat down and asked my new gyn to take my uterus out. He said it was limp and heavy, hence my inability to stand up straight or sit. My older relatives suggested removing my ovaries. I don't miss my uterus in the slightest. But, right now, I tremendously miss my ovaries even though I know their numbers were very close to menopause.

While seeing my current/new gyn, I added a new, local NP who has started her own business in hormone management to do my blood draws. My current gynecologist is retiring soon but will put me on with another one at his practice.

I have a dermatologist, too, who has overseen my vulvodynia for a few years.

But today and yesterday I was thinking I need a true BHRT menopause specialist who won't overload my lady parts with creams. My skin simply won't handle it.

I'm trying what I can right now from my gyn which is an Estradiol gel that I rub behind my knees and on my wrists, because my body was not absorbing the patch. I just had a blood draw yesterday to see how I'm doing on the gel. My gyn just added in a testosterone cream at a low dose to be rubbed on thin skin twice weekly. I have no libido.
He strongly advised me against any testosterone cream on the clitoris and labia. He'd seen clitotomegaly. My first menopause NP was very much for testosterone cream locally but the few times I tried it my skin turned hot so I told her no thanks.

It's a lot to navigate.

I do have both the micronized Progesterone 100mg as well as a compounded 50mg extended-release version. A few days ago the 100mg was giving me daytime depression so I stopped for two days but now I'm missing the calming, sleepy effect at bedtime.
I have a Progesterone cream that is supposed to be bioidentical. I rub it on my tummy some nights when I remember it.

I need to learn more about BHRT and what my body responds to best. I'm due to see my urologist next month. I see him every six months to get my urine checked, talk about IC pain and he's my Vagifem/Imvexxy back-up prescriber.

I'll look at the ZRT website. I really want one person who'll run bloodwork, educate me on BHRT, who is educated in GSM, will check my groin skin frequently for adverse effects and craft a plan.

Thank you for your detailed response. I will study it again and again.
Forgive me if I repeated myself from a previous post.