The way my doctor explained it, is that locally applied Estradiol to the vagina has a different impact on the body than oral HRT. That was my understanding and it suppoted the videos I had seen by female urologists online. My readings seemed to indicate that the locally applied estrogen may not be enough to address symptoms like hot flashes. I’m interested in oral HRT and will explore it further. Based on what some of these urologists and gynecologists are saying about pelvic atrophy, I want to be proactive.