Intrauterine devices (IUD) are a widely used and reliable long-acting contraceptive method, favored for their convenience and cost-effectiveness, and commonly inserted by family physicians in Portugal. Although uterine perforation is one of the most serious complications associated with IUD use, it remains rare and may be clinically silent. Following perforation, the device may migrate and be found in adjacent structures, with ectopic locations reported in the omentum, mesentery, pouch of Douglas, colon, and bladder.We report the case of a 39-year-old Portuguese woman (G2P2) who underwent successful placement of a 52-mg levonorgestrel-releasing IUD on August 9, 2024, during a consultation with her family physician, without complications. Following the procedure, she experienced two days of colicky suprapubic pain accompanied by light vaginal spotting, which resolved spontaneously, and she subsequently remained asymptomatic. Eleven months after insertion, she presented again to her family physician with complaints of menorrhagia. On physical examination, she reported no abdominal pain, and the IUD strings were not visualized. A subsequent transvaginal ultrasound revealed an empty uterus with no trace of the IUD. This prompted further investigation. Plain abdominal X-ray: IUD in an indeterminate location, projecting over the right pelvis. Given this result, a computed tomography (CT) scan of the pelvis was requested for clarification. The CT scan revealed the displaced IUD located in the right iliac fossa. After that, she was referred to hospital. The hospital gynecology team opted for laparoscopic removal of the IUD after imaging confirmed its intra-abdominal position and suggested favorable conditions for minimally invasive retrieval.This case highlights the importance of vigilance for mildly symptomatic uterine perforations, which are less commonly reported in the literature.Clinicians should maintain a high index of suspicion for IUD displacement or uterine perforation in women presenting with menorrhagia and no lower abdominal pain.IUD migration is an uncommon complication, immediate or delayed. Diagnosis requires imaging: ultrasound first-line but may miss extrauterine devices; abdominal X-ray helps, while CT provides superior localization and visualization accuracy.Clinicians should be aware of the possibility of a paucisymptomatic presentation and should consider this diagnosis in IUD users, particularly when new compatible symptoms arise.