<s>[INST] I have had the mirena iud for 3 months with approx 6 days of no bleeding here and there. Mostly it's been a tolerable spotting, for the past week I have been on a heavy period which is becoming lighter. Although I've had clots throughout the periods today I have seen a somewhat large size the length of a small tampon. Should I be worried? I have also been becoming lightheaded when I get up from laying down or sitting down in my own mind I think this is maybe anaemia? [/INST] Hello,Welcome to Healthcaremagic.Yes you may have anemia.But this needs either iron tablets or injection depends on your hemoglobin level in blood.Regarding your spotting and heavier bleeding, It is very common with Mirena IUD for initial 3 to 6 months.Thus your body needs adjustment for the Mirena IUD.After these 3 to 6 months, your body may adjust and your periods may resume to normal.So you do not need to worry too much about this. If you are my patient, I will prescribe iron tablets for 2 months after checking the hemoglobin concentration in blood. I ask you wait for 3 more months and review.Hope this helps.If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries. Wishing you good health.Regards,Dr.Manjeth </s>