Intrauterine device perforation is rare, yet remains one of the most serious complications of long-term IUD (Intrauterine Device) use. Although extrauterine migration has been reported in multiple pelvic and abdominal structures, chronic migration in postmenopausal women with very long retention periods is uncommon. We present a distinctive case involving a 60-year-old female patient who has retained a copper-T intrauterine device for a duration of 19 years without any subsequent medical follow-up and has been in a postmenopausal state for the past 17 years. She presented with a one-month history of abdominal pain. Ultrasonography and abdominal radiography demonstrated the absence of the device within the uterine cavity. Diagnostic laparoscopy elucidated the presence of the intrauterine device penetrating the posterior uterine wall and exhibiting a strong adherence to the right fallopian tube, extending towards the fimbriae, accompanied by substantial adhesions associated with copper. The device was successfully removed via laparoscopic adhesiolysis. This case highlights an unusual presentation of extrauterine IUD migration in which the strings remained visible at the external cervical os despite perforation and adnexal adhesion. Postmenopausal uterine atrophy, myometrial thinning, and the chronic inflammatory response induced by copper likely contributed to progressive erosion and adhesion formation. Current WHO and ACOG recommendations advise the removal of all migrated IUDs regardless of symptoms to prevent complications. The present case demonstrates that ongoing surveillance after IUD insertion and removal of the device following menopause is essential to prevent delayed perforation, chronic migration, and complex surgical retrieval.