“I had a horrible experience on the birth control pill. I’m 65. I want to use vaginal estrogen to prevent problems… but I’m terrified of anything systemic.” First — if this is you, you are not crazy. You are responding to a past experience. And that matters. But let’s separate oral birth control pills from low-dose vaginal estrogen. They are not the same therapy. Not the same dose. Not the same systemic exposure. Not the same risk profile. Birth control pills are systemic hormone therapy designe