Intrauterine devices (IUDs) are widely used, highly effective long-acting reversible contraceptives. However, complications such as IUD migration and uterine perforation can occur. A systematic review of case reports and series from 2002 to 2022 found that about half of the patients with migrated IUDs presented with pain, and a third were asymptomatic. The most common sites of migration were the intestine, bladder, and omentum. Laparoscopy is the preferred method for removing a migrated IUD, and generally, no lasting injuries occur. However, severe complications can occasionally arise. Uterine perforation is a rare complication, with an incidence of 0.3–2.6 per 1000 insertions for LNG-IUDs and 0.3–2.2 per 1000 insertions for Cu-IUDs. It may be asymptomatic or cause pain, abnormal bleeding, or bowel/bladder perforation. Diagnosis often involves imaging, with ultrasound being the first-line method. If the IUD is not visible on ultrasound, further imaging is needed. Removal is generally recommended in all cases of uterine perforation to prevent complications. IUDs should be removed in cases of perforation, even if asymptomatic, to avoid long-term damage. Follow-up is important, with clinical follow-up recommended after 4–12 weeks. If the IUD threads are not visible, an ultrasound should be performed. In some cases, two IUDs may be found in one patient. After confirming perforation, a new placement should be postponed for at least 2–6 weeks. Healthcare providers should be vigilant about these complications, especially in cases of painful insertion or other risk factors. The review highlights the importance of early detection and appropriate management to prevent serious complications.Intrauterine devices (IUDs) are widely used, highly effective long-acting reversible contraceptives. However, complications such as IUD migration and uterine perforation can occur. A systematic review of case reports and series from 2002 to 2022 found that about half of the patients with migrated IUDs presented with pain, and a third were asymptomatic. The most common sites of migration were the intestine, bladder, and omentum. Laparoscopy is the preferred method for removing a migrated IUD, and generally, no lasting injuries occur. However, severe complications can occasionally arise. Uterine perforation is a rare complication, with an incidence of 0.3–2.6 per 1000 insertions for LNG-IUDs and 0.3–2.2 per 1000 insertions for Cu-IUDs. It may be asymptomatic or cause pain, abnormal bleeding, or bowel/bladder perforation. Diagnosis often involves imaging, with ultrasound being the first-line method. If the IUD is not visible on ultrasound, further imaging is needed. Removal is generally recommended in all cases of uterine perforation to prevent complications. IUDs should be removed in cases of perforation, even if asymptomatic, to avoid long-term damage. Follow-up is important, with clinical follow-up recommended after 4–12 weeks. If the IUD threads are not visible, an ultrasound should be performed. In some cases, two IUDs may be found in one patient. After confirming perforation, a new placement should be postponed for at least 2–6 weeks. Healthcare providers should be vigilant about these complications, especially in cases of painful insertion or other risk factors. The review highlights the importance of early detection and appropriate management to prevent serious complications.