Pelvic actinomycosis is a rare condition mostly affecting sexually active old women. It affects the upper female reproductive system and is commonly encountered in those who have an IUD inserted. It could lead to pelvic inflammatory disease and subsequent complications that may mimic malignancy in serious sequelae. In this article, we report a case of tubo-ovarian actinomycosis in a perimenopausal women with neglected IUD. She presented with a tubo-ovarian abscess with adhesions.