Imaging of intrauterine contraceptive devices: a comprehensive pictorial review

Intrauterine contraceptive devices (IUCDs) are widely used, highly effective, and reversible methods of contraception. Despite their overall safety profile, IUCD malposition and complications May occur and are frequently asymptomatic or clinically unsuspected, posing a diagnostic challenge in daily practice. Imaging plays a central role in evaluating IUCD location, integrity, and associated complications, often in patients undergoing ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) for unrelated indications. Familiarity with the different types of IUCDs and their expected imaging appearances is essential for accurate interpretation. Proper positioning requires complete intrauterine placement with fundal orientation, while deviations May represent a spectrum of malposition, including expulsion, displacement, embedment, and uterine perforation. Additional complications such as fragmentation, missing retrieval strings, pelvic inflammatory disease, actinomycosis, and pregnancy with an IUCD in situ further broaden the differential diagnosis. Recognition of key imaging features and common diagnostic pitfalls is critical, as some findings warrant prompt clinical communication and intervention. Integrating this knowledge into routine imaging assessment enhances diagnostic accuracy, supports appropriate clinical management, and reduces the risk of overlooked IUCD-related complications.