"i gave it a rating of 5 for its effectiveness in preventing pregnancy. i only do withdrawal method with this. but the side effects are so awful. possibly the worst i&#039;ve had with any brand. it is quite potent  i&#039;d tell you that. i get a lot of headaches, nausea and stomach discomforts for a week into starting a new pack, decreased libido, and in the beginning i&#039;m quite dry which is uhm, have never been an issue for me, i get so moody, stress is harder to deal with, i get anxiety attacks, i get so easily fatigued, and the combination of these 2 i just get so unmotivated into doing daily activities. it&#039;s pretty bad. i&#039;m changing brands on my next cycle. maybe a milder combination ocp."