I am 50 and in perimenopause according to blood work. I had the mirena and didn't have periods for years. When I finally had it removed I had a very heavy period- filling a pad once an hour. I almost had to go to the ER. But no periods since because my ob/gyn put me on progesterone pills to lighten my periods but I haven't had even spotting since that heavy period- back in March. I'm not having hot flashes yet.