@laura1970 , I’m no expert but I have been told by all my doctors that the local Estradiol cream does not enter into the system the way HRT does. That’s why even doctors who do not prescribe HRT , do prescribe local Estradiol. I’ve also read it multiple places and heard female urologists say the same thing in their you tube videos. If course, using it is a personal decision, but I’m annoyed no doctor ever offered it to me. I discovered it myself and requested it.