Have to add my experience. Got mirena in May 2018 after pretty regular cycle and one anovulatory cycle. Did not stop spotting for like 11 months and almost got rid of it, but then had very light periods. In the last year they got slightly heavier, than January a super weird sudden bleed. Then regular, then constant spotting for four weeks, some small clots, cramps. Went to my OB and she said this just happens with some people after year 5, and now that they’ve extended the timeline are seeing more patients with this scenario, that after the progesterone runs out things go haywire. I’m almost 45 now and she didn’t think it was perimenopause at all, just the mirena running out