What can I expect when I start my first period with mirena?

It could be spotting, it is a little early for your period isnt it? If you had your period the week prior to insertion, your period would not be due quite yet. Some women do spot and this is very normal. you may have heavier bleeding or you may have lighter or you may not notice much difference. some women experience heavier bleeding and cramping with most IUDs but some women breeze through. I think either you love IUDs or you hate them. Every woman is SO very different in her response it is hard to say what you can expect really. I hope that they warned you off the things to look for. IUDs carry a higher risk for ectopic pregnancy (or a pregnancy that imbeds in the fallopian tube instead of the womb or uterus where it belong) and they also carry higher risk for PID-pelvic inflammatory disease. Here are the FDAs main patient warnings:
Ectopic Pregnancy
Evaluate women who become pregnant while using Mirena (levonorgestrel-releasing intrauterine system) for ectopic pregnancy. Up to half of pregnancies that occur with Mirena (levonorgestrel-releasing intrauterine system) in place are ectopic. The incidence of ectopic pregnancy in clinical trials that excluded women with risk factors for ectopic pregnancy was approximately 0.1% per year.

Tell women who choose Mirena (levonorgestrel-releasing intrauterine system) about the risks of ectopic pregnancy, including the loss of fertility. Teach them to recognize and report to their physician promptly any symptoms of ectopic pregnancy. Women with a previous history of ectopic pregnancy, tubal surgery or pelvic infection carry a higher risk of ectopic pregnancy.

The risk of ectopic pregnancy in women who have a history of ectopic pregnancy and use Mirena (levonorgestrel-releasing intrauterine system) is unknown. Clinical trials of Mirena (levonorgestrel-releasing intrauterine system) excluded women with a history of ectopic pregnancy.

Intrauterine Pregnancy
If pregnancy should occur with Mirena (levonorgestrel-releasing intrauterine system) in place, Mirena (levonorgestrel-releasing intrauterine system) should be removed. Removal or manipulation of Mirena (levonorgestrel-releasing intrauterine system) may result in pregnancy loss. In the event of an intrauterine pregnancy with Mirena (levonorgestrel-releasing intrauterine system) , consider the following:

Septic abortion
In patients becoming pregnant with an IUD in place, septic abortion—with septicemia, septic shock, and death—may occur.

Continuation of pregnancy
If a woman becomes pregnant with Mirena (levonorgestrel-releasing intrauterine system) in place and if Mirena (levonorgestrel-releasing intrauterine system) cannot be removed or the woman chooses not to have it removed, she should be warned that failure to remove Mirena (levonorgestrel-releasing intrauterine system) increases the risk of miscarriage, sepsis, premature labor and premature delivery. She should be followed closely and advised to report immediately any flu-like symptoms, fever, chills, cramping, pain, bleeding, vaginal discharge or leakage of fluid.

Long-term effects and congenital anomalies
When pregnancy continues with Mirena (levonorgestrel-releasing intrauterine system) in place, long-term effects on the offspring are unknown. As of September 2006, 390 live births out of an estimated 9.9 million Mirena (levonorgestrel-releasing intrauterine system) users had been reported. Congenital anomalies in live births have occurred infrequently. No clear trend towards specific anomalies has been observed. Because of the intrauterine administration of levonorgestrel and local exposure of the fetus to the hormone, the possibility of teratogenicity following exposure to Mirena (levonorgestrel-releasing intrauterine system) cannot be completely excluded. Some observational data support a small increased risk of masculinization of the external genitalia of the female fetus following exposure to progestins at doses greater than those currently used for oral contraception. Whether these data apply to Mirena (levonorgestrel-releasing intrauterine system) is unknown.

Sepsis
As of September 2006, 9 cases of Group A streptococcal sepsis (GAS) out of an estimated 9.9 million Mirena (levonorgestrel-releasing intrauterine system) users had been reported. In some cases, severe pain occurred within hours of insertion followed by sepsis within days. Because death from GAS is more likely if treatment is delayed, it is important to be aware of these rare but serious infections. Aseptic technique during insertion of Mirena (levonorgestrel-releasing intrauterine system) is essential. GAS sepsis may also occur postpartum, after surgery, and from wounds.

Pelvic Inflammatory Disease (PID)
Mirena (levonorgestrel-releasing intrauterine system) is contraindicated in the presence of known or suspected PID or in women with a history of PID unless there has been a subsequent intrauterine pregnancy. Use of IUDs has been associated with an increased risk of PID. The highest risk of PID occurs shortly after insertion (usually within the first 20 days thereafter) [see WARNINGS AND PRECAUTIONS]. A decision to use Mirena (levonorgestrel-releasing intrauterine system) must include consideration of the risks of PID.

Women at increased risk for PID
PID is often associated with a sexually transmitted disease, and Mirena (levonorgestrel-releasing intrauterine system) does not protect against sexually transmitted disease. The risk of PID is greater for women who have multiple sexual partners, and also for women whose sexual partner(s) have multiple sexual partners. Women who have had PID are at increased risk for a recurrence or re-infection.

PID warning to Mirena (levonorgestrel-releasing intrauterine system) users
All women who choose Mirena (levonorgestrel-releasing intrauterine system) must be informed prior to insertion about the possibility of PID and that PID can cause tubal damage leading to ectopic pregnancy or infertility, or infrequently can necessitate hysterectomy, or cause death. Patients must be taught to recognize and report to their physician promptly any symptoms of pelvic inflammatory disease. These symptoms include development of menstrual disorders (prolonged or heavy bleeding), unusual vaginal discharge, abdominal or pelvic pain or tenderness, dyspareunia, chills, and fever.

Asymptomatic PID
PID may be asymptomatic but still result in tubal damage and its sequelae.

Treatment of PID
Following a diagnosis of PID, or suspected PID, bacteriologic specimens should be obtained and antibiotic therapy should be initiated promptly. Removal of Mirena (levonorgestrel-releasing intrauterine system) after initiation of antibiotic therapy is usually appropriate. Guidelines for PID treatment are available from the Centers for Disease Control (CDC), Atlanta, Georgia.

Actinomycosis has been associated with IUDs. Symptomatic women with IUDs should have the IUD removed and should receive antibiotics. However, the management of the asymptomatic carrier is controversial because actinomycetes can be found normally in the genital tract cultures in healthy women without IUDs. False positive findings of actinomycosis on Pap smears can be a problem. When possible, confirm the Pap smear diagnosis with cultures.

Irregular Bleeding and Amenorrhea
Mirena (levonorgestrel-releasing intrauterine system) can alter the bleeding pattern and result in spotting, irregular bleeding, heavy bleeding, oligomenorrhea and amenorrhea. During the first three to six months of Mirena (levonorgestrel-releasing intrauterine system) use, the number of bleeding and spotting days may be increased and bleeding patterns may be irregular. Thereafter the number of bleeding and spotting days usually decreases but bleeding may remain irregular. If bleeding irregularities develop during prolonged treatment, appropriate diagnostic measures should be taken to rule out endometrial pathology.

Amenorrhea develops in approximately 20% of Mirena (levonorgestrel-releasing intrauterine system) users by one year. The possibility of pregnancy should be considered if menstruation does not occur within six weeks of the onset of previous menstruation. Once pregnancy has been excluded, repeated pregnancy tests are generally not necessary in amenorrheic women unless indicated, for example, by other signs of pregnancy or by pelvic pain [see Clinical Studies].

In most women with heavy menstrual bleeding, the number of bleeding and spotting days may also increase during the initial months of therapy but usually decrease with continued use; the volume of blood loss per cycle progressively becomes reduced [see Clinical Studies].

Embedment
Embedment of Mirena (levonorgestrel-releasing intrauterine system) in the myometrium may occur. Embedment may decrease contraceptive effectiveness and result in pregnancy [see WARNINGS AND PRECAUTIONS]. An embedded Mirena (levonorgestrel-releasing intrauterine system) should be removed. Embedment can result in difficult removal and, in some cases surgical removal may be necessary.

Perforation
Perforation or penetration of the uterine wall or cervix may occur during insertion although the perforation may not be detected until some time later. If perforation occurs, pregnancy may result [see WARNINGS AND PRECAUTIONS]. Mirena (levonorgestrel-releasing intrauterine system) must be located and removed; surgery may be required. Delayed detection of perforation may result in migration outside the uterine cavity, adhesions, peritonitis, intestinal perforations, intestinal obstruction, abscesses and erosion of adjacent viscera.

The risk of perforation may be increased in lactating women, in women with fixed retroverted uteri, and during the postpartum period. To decrease the risk of perforation postpartum, Mirena (levonorgestrel-releasing intrauterine system) insertion should be delayed a minimum of 6 weeks after delivery or until uterine involution is complete. If involution is substantially delayed, consider waiting until 12 weeks postpartum. Inserting Mirena (levonorgestrel-releasing intrauterine system) immediately after first trimester abortion is not known to increase the risk of perforation, but insertion after second trimester abortion should be delayed until uterine involution is complete.

Expulsion
Partial or complete expulsion of Mirena (levonorgestrel-releasing intrauterine system) may occur [see WARNINGS AND PRECAUTIONS].

Symptoms of the partial or complete expulsion of any lUD may include bleeding or pain. However, the system can be expelled from the uterine cavity without the woman noticing it, resulting in the loss of contraceptive protection. Partial expulsion may decrease the effectiveness of Mirena (levonorgestrel-releasing intrauterine system) . As menstrual flow typically decreases after the first 3 to 6 months of Mirena (levonorgestrel-releasing intrauterine system) use, an increase of menstrual flow may be indicative of an expulsion. If expulsion has occurred, Mirena (levonorgestrel-releasing intrauterine system) may be replaced within 7 days of a menstrual period after pregnancy has been ruled out.

Ovarian Cysts
Since the contraceptive effect of Mirena (levonorgestrel-releasing intrauterine system) is mainly due to its local effect, ovulatory cycles with follicular rupture usually occur in women of fertile age using Mirena (levonorgestrel-releasing intrauterine system) . Sometimes atresia of the follicle is delayed and the follicle may continue to grow. Enlarged follicles have been diagnosed in about 12% of the subjects using Mirena (levonorgestrel-releasing intrauterine system) . Most of these follicles are asymptomatic, although some may be accompanied by pelvic pain or dyspareunia. In most cases the enlarged follicles disappear spontaneously during two to three months observation. Persistent enlarged follicles should be evaluated. Surgical intervention is not usually required.

Breast Cancer
Women who currently have or have had breast cancer, or have a suspicion of breast cancer, should not use hormonal contraception because breast cancer is a hormone-sensitive tumor.

Spontaneous reports of breast cancer have been received during postmarketing experience with Mirena (levonorgestrel-releasing intrauterine system) . Because spontaneous reports are voluntary and from a population of uncertain size, it is not possible to use postmarketing data to reliably estimate the frequency or establish causal relationship to drug exposure. Two observational studies have not provided evidence of an increased risk of breast cancer during the use of Mirena (levonorgestrel-releasing intrauterine system) .

Patient Evaluation and Clinical Considerations
A complete medical and social history, including that of the partner, should be obtained to determine conditions that might influence the selection of an IUD for contraception [see CONTRAINDICATIONS].
Special attention must be given to ascertaining whether the woman is at increased risk of infection (for example, leukemia, acquired immune deficiency syndrome (AIDS), I.V. drug abuse), or has a history of PID unless there has been a subsequent intrauterine pregnancy. Mirena (levonorgestrel-releasing intrauterine system) is contraindicated in these women.
A physical examination should include a pelvic examination, a Pap smear, examination of the breasts, and appropriate tests for any other forms of genital or other sexually transmitted diseases, such as gonorrhea and chlamydia laboratory evaluations, if indicated. Use of Mirena (levonorgestrel-releasing intrauterine system) in patients with vaginitis or cervicitis should be postponed until proper treatment has eradicated the infection and until it has been shown that the cervicitis is not due to gonorrhea or chlamydia [see CONTRAINDICATIONS].
Irregular bleeding may mask symptoms and signs of endometrial polyps or cancer. Because irregular bleeding/spotting is common during the first months of Mirena (levonorgestrel-releasing intrauterine system) use, exclude endometrial pathology prior to the insertion of Mirena (levonorgestrel-releasing intrauterine system) in women with persistent or uncharacteristic bleeding. If unexplained bleeding irregularities develop during the prolonged use of Mirena (levonorgestrel-releasing intrauterine system) , appropriate diagnostic measures should be taken [see WARNINGS AND PRECAUTIONS].
The healthcare provider should determine that the patient is not pregnant. The possibility of insertion of Mirena (levonorgestrel-releasing intrauterine system) in the presence of an existing undetermined pregnancy is reduced if insertion is performed within 7 days of the onset of a menstrual period. Mirena (levonorgestrel-releasing intrauterine system) can be replaced by a new system at any time in the cycle. Mirena (levonorgestrel-releasing intrauterine system) can be inserted immediately after first trimester abortion.
Mirena (levonorgestrel-releasing intrauterine system) should not be inserted until 6 weeks postpartum or until involution of the uterus is complete in order to reduce the incidence of perforation and expulsion. If involution is substantially delayed, consider waiting until 12 weeks postpartum [see WARNINGS AND PRECAUTIONS].
Patients with certain types of valvular or congenital heart disease and surgically constructed systemic-pulmonary shunts are at increased risk of infective endocarditis. Use of Mirena (levonorgestrel-releasing intrauterine system) in these patients may represent a potential source of septic emboli. Patients with known congenital heart disease who may be at increased risk should be treated with appropriate antibiotics at the time of insertion and removal.
Patients requiring chronic corticosteroid therapy or insulin for diabetes should be monitored with special care for infection.
Mirena (levonorgestrel-releasing intrauterine system) should be used with caution in patients who have:
Coagulopathy or are receiving anticoagulants
Migraine, focal migraine with asymmetrical visual loss or other symptoms indicating transient cerebral ischemia
Exceptionally severe headache
Marked increase of blood pressure
Severe arterial disease such as stroke or myocardial infarction

This is not intended to scare you just to make you aware of what to look for. Be sure that you read any instructions they gave you thoroughly and ask questions of your provider if there is anything you dont understand or you can post again and we will try to answer them for you! Good Luck-hope it does well for you!