Use of long-acting reversible contraceptive (LARC) devices among adolescent patients has increased significantly over the past decade In 2002, only 2.4% of young women used these devices, but by 2013 more than 11.6% were using one of these methods There are two main types of LARC devices—IUDs and subdermal hormonal implants Although side effects are rare, ED clinicians should be aware of complications that represent potential clinical emergencies CLINICAL PEARLS AND PITFALLS Recognize when patients who have a contraceptive device in place may be presenting with symptoms suggestive of a complication Provide guidance on the optimal process for evaluating complications related to use of a contraceptive device INTRAUTERINE DEVICES Clinical Manifestations Serious complications related to having a contraceptive device place are rare Among IUD users, rare, but serious side effects include pregnancy, uterine perforation, expulsion, and infection Pregnancies with an in situ IUD have a higher risk of being an ectopic pregnancy and, if the IUD is left in place, women are more likely to experience a spontaneous abortion or prolonged bleeding The risk of perforation is low, and is estimated to be in 1,000; most occur within months of insertion Clinical symptoms of perforation include persistent or worsening pain, bleeding, hematuria, abdominal distention, and fever Perforations are usually fundal and, given that the device has no sharp edges and that no incisions or sharp instruments are placed in the uterus during the procedure, are generally not associated with hemorrhage or damage to internal visceral organs However, cervical perforation or lateral perforation at the level of the internal cervical os or within the uterus can result in vascular disruption with associated hemodynamic changes, including hemodynamic instability Anterior perforation may result in damage to the bladder, which may present with suprapubic pain, dysuria, or persistent vaginal leakage of fluid The diagnosis may be made based on clinical symptoms or with an ultrasound Abdominal as well as transvaginal images are generally necessary to confirm the diagnosis, with 3D ultrasound providing greater sensitivity, particularly in obese women and