I got mine removed early, as I had peri menopausal symptoms (although at the time they said that wasn’t it, I was too young). Fast forward a few years and I have another.
For my first one, when all was well, I had no bleeds. While I HD no bleeds, I had cyclical symptoms of ovulation pain and then mood problems (flat, withdrawn, irrational) for a few days 2 weeks after the ovulation pains. Then at the 3 year mark (I think?) I had a surprise bleed (no noticeable period symptoms for that). That fall, I had extreme vaginal dryness, painful intercourse, then huge painful boobs, and eventually a period. Things definitely fluctuating beyond normal range for me. The OB-GYN offered to replace with another Mirena but I wanted off the roller coaster and went on the pill. That ended up being a mistake, but hindsight is 20/20!